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Roussos S, Angelopoulos T, Cholongitas E, Savvanis S, Papadopoulos N, Kapatais A, Chounta A, Ioannidou P, Deutsch M, Manolakopoulos S, Sevastianos V, Papageorgiou MV, Vlachogiannakos I, Mela M, Elefsiniotis I, Vrakas S, Karagiannakis D, Pliarchopoulou F, Chaikalis S, Tsirogianni E, Psichogiou M, Kalamitsis G, Leobilla F, Paraskevis D, Malliori M, Goulis I, Papatheodoridis G, Hatzakis A, Sypsa V. High levels of all-cause mortality among people who inject drugs from 2018 to 2022. Int J Drug Policy 2024; 126:104356. [PMID: 38394950 DOI: 10.1016/j.drugpo.2024.104356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Mortality among people who inject drugs (PWID) is high, with overdose and HIV infection being the main causes of death. In Greece, there have been no data on mortality, and two HIV outbreaks have been recorded in this population in the past decade. In this study, we aim to estimate the all-cause crude mortality rate and the standardised mortality ratio in this population during 2018-2022. METHODS PWID recruited from two community-based programs in Athens and Thessaloniki during 2018-2021 were interviewed and tested for HIV/HCV. Data on vital status (deceased/alive) and date of death were obtained from death registries through December 31, 2022. All-cause crude mortality rates (CMR) and standardised mortality ratios (SMR) were estimated. Determinants of mortality were assessed using Cox proportional-hazards model. RESULTS Of 2,530 participants, 301 died over 8,543 person-years (PYs) of follow-up. The CMR (95 % CI) was 3.52 (3.15-3.94) deaths per 100 PYs; 3.10 per 100 PYs (2.68-3.58) in Athens and 4.48 per 100 PYs (3.74-5.37) in Thessaloniki. An increasing trend in CMR was identified over 2018-2022 in Athens (from 2.90 to 4.11 per 100 PYs, 41.5 % increase, p = 0.018). The pooled SMR (95 % CI) was 15.86 (14.17-17.76) for both cities and was particularly increased in younger individuals, females, those injecting daily, not enrolled to opioid agonist treatment and HIV-infected individuals. Older age, living in Thessaloniki, Greek origin, homelessness, history of injection in the past 12 months, and HIV infection were independently associated with higher risk of death. CONCLUSION Mortality among PWID in the two largest cities (Athens and Thessaloniki) in Greece in 2018-2022 was high, with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens may reflect the long-term impact of the COVID-19 pandemic. Preventive programs such as take-home naloxone, screening and treatment for HIV, are urgently needed.
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Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Angelopoulos
- Gastroenterology Resident, Gastroenterology Department, G.H.A. Korgialeneio Mpenakeio Hellenic Red Cross, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine, General Hospital of Athens "Elpis", Athens, Greece
| | - Nikolaos Papadopoulos
- 2nd Department of Internal Medicine, 401 General Army Hospital of Athens, Athens, Greece
| | - Andreas Kapatais
- 1st Department of Internal Medicine, Western Attica General Hospital "Agia Varvara", Athens, Greece
| | - Athina Chounta
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Panagiota Ioannidou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Melani Deutsch
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | - Spilios Manolakopoulos
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | | | - Maria-Vasiliki Papageorgiou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Ioannis Vlachogiannakos
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Maria Mela
- Department of Gastroenterology, Evangelismos General Hospital, Athens, Greece
| | - Ioannis Elefsiniotis
- Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Vrakas
- Department of Gastroenterology, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Fani Pliarchopoulou
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Savvas Chaikalis
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Effrosyni Tsirogianni
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Meni Malliori
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papatheodoridis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Roussos S, Paraskevis D, Psichogiou M, Kostaki EG, Flountzi E, Angelopoulos T, Chaikalis S, Papadopoulou M, Pavlopoulou ID, Malliori M, Hatzitheodorou E, Pylli M, Tsiara C, Paraskeva D, Beloukas A, Kalamitsis G, Hatzakis A, Sypsa V. Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014-20). Addiction 2022; 117:1670-1682. [PMID: 35072299 DOI: 10.1111/add.15812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011-13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV-1 dispersal using molecular methods during 2014-20. METHODS Two community-based HIV/hepatitis C programmes on PWID were implemented in 2012-13 (n = 3320) and 2018-20 (n = 1635) through consecutive respondent-driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS-weighted HIV prevalence estimates per round for 2018-20 and compared them to 2012-13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person-years during 2014-20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters. RESULTS HIV prevalence per round ranged between 12.0 and 16.2% in 2012-13 and 10.7 and 11.3% in 2018-20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7-17.1%) in 2012-13 to 22.0% (19.0-25.3%) in 2018-20 (P < 0.001). There was a deterioration in socio-economic characteristics such as homelessness [from 16.2% (95% CI = 13.5-19.2%) to 25.6% (22.3-29.0%)], a shift in cocaine use [16.6% (13.9-19.6%) versus 28.1% (24.7-31.7%], reduced access to free syringes [51.8% (48.0-55.7%) versus 44.5% (40.7-48.3%)] and a decrease in daily injecting [36.2% (32.6-39.9%) versus 28.5% (25.2-32.1%)]. HIV incidence (95% CI) in 2014-20 was 1.94 (1.50-2.52) new cases/100 person-years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster. CONCLUSIONS In Athens, Greece, compared with the period 2012-13, in the period 2018-20 there was a deterioration in socio-economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014-20 in existing as well as new transmission clusters.
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Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Flountzi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Angelopoulos
- Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Savvas Chaikalis
- Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Martha Papadopoulou
- Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece.,First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna D Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Meni Malliori
- Psychiatric Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Magdalini Pylli
- Hellenic National Public Health Organization, Marousi, Greece
| | - Chrissa Tsiara
- Hellenic National Public Health Organization, Marousi, Greece
| | | | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Athens, Greece.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Karagiannakis DS, Voulgaris T, Angelopoulos T, Ioannidou P, Cholongitas E, Vlachogiannakos J, Papatheodoridis GV. Comparative Utility of Transient and 2D Shear Wave Elastography for the Assessment of Liver Fibrosis in Clinical Practice. J Digit Imaging 2021; 34:1342-1348. [PMID: 34622378 PMCID: PMC8669084 DOI: 10.1007/s10278-021-00521-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/01/2021] [Accepted: 09/22/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of the study was to investigate the feasibility and correlation of liver stiffness measurements (LSM) between 2D-shear wave elastography (2D-SWE) and transient elastography (TE) in patients with chronic liver disease. Over 4 months, 421 patients with chronic liver disease of any cause underwent LSM by 2D-SWE and TE (M and/or XL probe) and controlled attenuation parameter at the same visit. LSM was not feasible by TE in 16 (3.8%) and by 2D-SWE in 17 (4.0%) patients. Median LSM were 8.9 and 8.7 kPa with TE and 2D-SWE, respectively, having a strong correlation (r = 0.774, p < 0.001) in the total cohort and in any cause of liver disease (r = 0.747-0.806, p < 0.001). There was a strong agreement on diagnosis of severe fibrosis (k-statistic: 0.841, p < 0.001) or cirrhosis (k-statistic: 0.823, p < 0.001). Both methods had increased failure rates in patients with obesity and/or increased waist circumference. Among 104 obese patients, TE was more feasible than 2D-SWE (92.3% vs 85.6%, p < 0.001]. LSM by 2D-SWE are strongly correlated to LSM by TE independently of the etiology of chronic liver disease, stage of fibrosis, degree of liver steatosis, and patients' characteristics. TE with the XL probe may be superior in a minority of obese patients.
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Affiliation(s)
- Dimitrios S Karagiannakis
- Academic Department of Gastroenterology, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece.
| | - Theodoros Voulgaris
- Academic Department of Gastroenterology, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Angelopoulos
- Academic Department of Gastroenterology, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Ioannidou
- Academic Department of Gastroenterology, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Jiannis Vlachogiannakos
- Academic Department of Gastroenterology, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece
| | - George V Papatheodoridis
- Academic Department of Gastroenterology, Medical School of National &, Laiko General Hospital, Kapodistrian University of Athens, Athens, Greece
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Doupis J, Kolokathis K, Markopoulou E, Efthymiou V, Festas G, Papandreopoulou V, Kallinikou C, Antikidou D, Gemistou G, Angelopoulos T. The Role of Pediatric BCG Vaccine in Type 1 Diabetes Onset. Diabetes Ther 2021; 12:2971-2976. [PMID: 34596880 PMCID: PMC8519972 DOI: 10.1007/s13300-021-01163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/22/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Bacille Calmette-Guérin (BCG) vaccination has shown promising therapeutic effects for type 1 diabetes (T1D). According to recent studies, immunometabolism modification and regulation of T lymphocytes constitute the proposed mechanisms by which BCG vaccination may delay T1D onset. Clinical trial evidence from Turkey supports that two to three doses of the BCG vaccine in childhood, with the first dose administered in the first year of life, may prevent T1D. In the same study, one or zero vaccinations appeared to have no effect in T1D onset prevention. In Greece, the BCG vaccine was administered in a single dose at the age of 9 years in elementary school. BCG vaccination was not performed on a mandatory basis, creating one BCG vaccinated and one non-vaccinated population. The aim of our study was to investigate the possible effect of a single dose of BCG vaccine, at the age of 9 years, on the time of T1D onset, in a population of BCG vaccinated and non-vaccinated patients with diagnosed T1D. METHODS To test this hypothesis, a survey through the Pan-Hellenic Federation of People with Diabetes (PFPD) was performed. In this observational, retrospective study, participating patients provided information regarding age, gender, time of diagnosis, and BCG vaccination status. Patients diagnosed with T1D before the age of 9 years were excluded from the analysis. RESULTS The final sample included 196 patients (73 male and 123 female) with a mean age of 42.2 ± 14.3 years and a mean duration of diabetes of 16.8 ± 12.9 years. Mean age of T1D diagnosis in the BCG vaccinated group was 24.0 ± 19.0 years, while the mean age of T1D diagnosis in the BCG non-vaccinated group was 21.5 ± 14.3 years (p = 0.03). No interaction was found between gender and the age of diagnosis for BCG vaccinated and unvaccinated patients (p = 0.86). CONCLUSION The results of our study suggest that a single dose of BCG vaccine, performed at the age of 9 years, may delay the onset of T1D by 2.5 years. Additional studies of children receiving multiple doses of BCG should be conducted to possibly prove prolongation of the disease-free interval.
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Affiliation(s)
- John Doupis
- Internal Medicine and Diabetes Department, Salamis Naval and Veterans Hospital, Salamis, Greece.
- Iatriko Paleou Falirou Medical Center, Diabetes Clinic, Athens, Greece.
| | | | - Eftychia Markopoulou
- Internal Medicine and Diabetes Department, Salamis Naval and Veterans Hospital, Salamis, Greece
| | - Vasiliki Efthymiou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - George Festas
- Internal Medicine and Diabetes Department, Salamis Naval and Veterans Hospital, Salamis, Greece
| | | | | | - Despina Antikidou
- Iatriko Paleou Falirou Medical Center, Diabetes Clinic, Athens, Greece
| | - Golfo Gemistou
- Pan-Hellenic Federation of People with Diabetes, Athens, Greece
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Voulgaris T, Karagiannakis D, Siakavellas S, Kalogera D, Angelopoulos T, Chloupi E, Karamanolis G, Papatheodoridis G, Vlachogiannakos J. High prevalence of asymptomatic peptic ulcers diagnosed during screening endoscopy in patients with cirrhosis. Ann Gastroenterol 2019; 32:451-456. [PMID: 31474790 PMCID: PMC6686096 DOI: 10.20524/aog.2019.0399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Peptic ulcer disease (PUD) is more prevalent in cirrhotics and this may aggravate prognosis. We investigated the prevalence of PUD in cirrhotics and its potential association with Helicobacter pylori (H. pylori) infection, the underlying etiology and severity of liver disease, and other manifestations of portal hypertension (PH). Methods: We enrolled consecutive asymptomatic cirrhotic patients who underwent screening endoscopy in a tertiary hospital during a 12-month period. We recorded the presence of PUD and the endoscopic findings associated with PH. H. pylori infection was documented through either histology or CLO-test. The diagnosis of cirrhosis was based on elastography, liver biopsy or a combination of clinical, biochemical and imaging data. Results: One hundred patients (M/F: 54/46, mean age: 61±14 years) were included in the analysis. Viral hepatitis (37%) and alcohol (22%) were the most common causes of cirrhosis. Child-Pugh stage was A/B/C: 60/35/5. PUD was found in 19 patients (14 gastric, 5 duodenal). H. pylori infection was diagnosed in 54%. Varices were detected in 59% (39% needed treatment). PH gastropathy was present in 81% (severe in 33%). The presence of PUD was unrelated to the etiology and the severity of liver disease or to other endoscopic manifestations of PH. No correlation was found between PUD and H. pylori infection. Conclusions: A high prevalence of PUD was observed in our cirrhotic patients, although they were asymptomatic and had no known risk factors of ulcerogenicity. The value of screening endoscopy for the early diagnosis and treatment of PUD in cirrhotics deserves further investigation.
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Affiliation(s)
- Theodoros Voulgaris
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Spyridon Siakavellas
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Despina Kalogera
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Theodoros Angelopoulos
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Elissavet Chloupi
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Karamanolis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Papatheodoridis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - John Vlachogiannakos
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
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Koumarianou A, Nikou G, Dimitroulopoulos D, Angelopoulos T, Papamichelakis M, Mandanas S, Chrisoulidou A, Vlachou E, Alexandrakis G, Papakostas P, Vaslamatzis M, Kaldrymidis P, Malachias A, Alevizopoulos N, Katsaounis P, Markussis V, Pazaitou K. Clinicopathologic considerations of neuroendocrine tumors (NETs) in Greece: A registry experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - George Nikou
- Gastrenterology Department, Laiko University Hospital, Athens, Greece
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Angelopoulos T, Kokkinos A, Liaskos C, Tentolouris N, Alexiadou K, Miras AD, Mourouzis I, Perrea D, Pantos C, Katsilambros N, Bloom SR, le Roux CW. The effect of slow spaced eating on hunger and satiety in overweight and obese patients with type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2014; 2:e000013. [PMID: 25452861 PMCID: PMC4212566 DOI: 10.1136/bmjdrc-2013-000013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/27/2014] [Accepted: 06/13/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Slow spaced eating is associated with improved satiety and gut hormone responses in normal-weight participants. This crossover study compared the effect of slow and rapid eating patterns on hunger, fullness, glucose, insulin, and the appetite-related gut hormones peptide YY (PYY), glucagon-like peptide-1 (GLP-1), and ghrelin in overweight and obese participants with type 2 diabetes mellitus (T2DM). METHODS 20 overweight and obese participants with T2DM on metformin were recruited. A test meal of 300 mL ice-cream was consumed in random order in two different sessions by each participant; meal duration was 5 or 30 min. Fullness and hunger as assessed by visual analog scales (VAS), and glucose, insulin, PYY, GLP-1, and ghrelin were measured at baseline and at 30 min intervals after meal termination for 3 h. RESULTS Fullness VAS ratings were significantly higher at the 90', 120', 150', and 180' time points and hunger ratings were lower at 90', 150', and 180' for the 30 min meal. The area under the curve (AUC) for fullness was higher after the 30 min meal than after the 5 min meal (11 943.7±541.2 vs 10 901.0±568.8 mm min, p=0.003) whereas the hunger AUC was lower (4442.9±328 vs 4966.7±347.5 mm min, p=0.012). There were no differences in glucose, insulin, PYY, GLP-1, and ghrelin responses. CONCLUSIONS Slow spaced eating increased fullness and decreased hunger ratings in overweight and obese participants with T2DM, without the improvement in gut hormone responses found in normal-weight participants. Slow spaced eating may be a useful prevention strategy, but might also help curb food intake in those already suffering from obesity and diabetes.
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Affiliation(s)
- Theodoros Angelopoulos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Christos Liaskos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Kleopatra Alexiadou
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | | | - Iordanis Mourouzis
- Department of Pharmacology, Athens University Medical School, Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, Athens University Medical School, Athens, Greece
| | - Constantinos Pantos
- Department of Pharmacology, Athens University Medical School, Athens, Greece
| | - Nicholas Katsilambros
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | - Stephen R Bloom
- Department of Metabolic Medicine, Hammersmith Hospital, Imperial College, London, UK
| | - Carel Wynard le Roux
- Department of Metabolic Medicine, Hammersmith Hospital, Imperial College, London, UK
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Angelopoulos T, Adler A, Krey L, Licciardi F, Noyes N, McCullough A. Enhancement or initiation of testicular sperm motility by in vitro culture of testicular tissue. Fertil Steril 1999; 71:240-3. [PMID: 9988391 DOI: 10.1016/s0015-0282(98)00434-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe different techniques of testicular tissue culture and their effect on sperm motility, mainly in cases of totally immotile spermatozoa, and to compare the effect of in vitro culture with that of motility stimulants. DESIGN Prospective study. SETTING University teaching hospital. PATIENT(S) Ten patients undergoing testicular biopsy for diagnostic purposes or for intracytoplasmic sperm injection. INTERVENTION(S) Dissected testicular biopsy samples and tissue blocks were cultured at 37 degrees C for up to 96 hours. Immediately after dissection, immotile testicular spermatozoa were incubated for 30 minutes in pentoxifylline and 2-deoxyadenosine. MAIN OUTCOME MEASURE(S) Sperm motility and vitality. RESULT(S) Overall, dissected samples showed improved sperm motility, which peaked within 48 hours of culture. Unlike motility, vitality declined linearly, from 56.3%+/-19% at initial assessment to 18.8%+/-11% at 96 hours. Five samples had initially immotile spermatozoa, of which four acquired motility at 48 hours. In vitro culture showed results comparable with those of incubation with pentoxifylline and 2-deoxyadenosine. Culture of tissue blocks did not improve motility or vitality compared with dissected tissue. CONCLUSION(S) The motility of testicular spermatozoa was enhanced or initiated after in vitro culture. Testicular biopsy culture may be an alternative to the use of motility stimulants to obtain motile spermatozoa for intracytoplasmic sperm injection, particularly when oocytes are not immediately available.
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Affiliation(s)
- T Angelopoulos
- Department of Obstetrics and Gynecology, New York University Medical Center, New York 10016, USA
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Angelopoulos T, Moshel YA, Lu L, Macanas E, Grifo JA, Krey LC. Simultaneous assessment of sperm chromatin condensation and morphology before and after separation procedures: effect on the clinical outcome after in vitro fertilization. Fertil Steril 1998; 69:740-7. [PMID: 9548167 DOI: 10.1016/s0015-0282(98)00016-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To look for correlations between acridine orange (AO) staining and semen parameters before and after sperm separation procedures and to assess whether the AO test predicts fertilization or pregnancy outcomes after standard IVF and intracytoplasmic sperm injection. DESIGN Prospective study that simultaneously assesses sperm morphology and nuclear protein maturity on a cell-by-cell basis before and after preparative procedures. SETTING University teaching hospital. PATIENT(S) Men (n = 140) undergoing diagnostic semen analysis. MAIN OUTCOME MEASURE(S) Acridine orange fluorescence of sperm nuclei, semen parameters, IVF outcome. RESULT(S) In unprocessed samples, 90% of sperm with normal heads displayed green fluorescence (mature nuclear protein); significantly lower percentages of green fluorescence were observed in sperm with abnormal heads. The percentage of mature normal sperm in the specimen correlated with motility. Sperm maturity after swim-up or Percoll gradient was significantly improved for sperm with normal or abnormal heads. The percentage of mature normal sperm correlated with motility after either Percoll or swim-up. Neither the percentages of mature nuclei nor mature normal nuclei correlated with fertilization or pregnancy outcome. CONCLUSION(S) Nuclear protein maturation correlates with sperm motility and morphology. Because morphologically normal and motile sperm are more mature, separation procedures should generate a population of sperm with the highest fertilization capacity. Acridine orange staining, however, did not predict fertilization efficiency or pregnancy outcome in IVF cycles.
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Affiliation(s)
- T Angelopoulos
- Department of Obstetrics and Gynecology, New York University Medical Center, New York 10016, USA
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10
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Abstract
Although round spermatids have been studied extensively using staining techniques and electron microscopy, little information is available about their appearance in living conditions. We describe a method of collecting and identifying round spermatids from ejaculates and testicular biopsies. The validity of the selection procedure was confirmed by fluorescence in-situ hybridization. Based on cell size, morphological characteristics of nucleus and cytoplasm, and on the nucleus/cytoplasm ratio, we harvested a population of cells that was 84% haploid. This procedure can be applied to select spermatids for clinical or research purposes.
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Affiliation(s)
- T Angelopoulos
- Department of Obstetrics and Gynecology, New York University Medical Center, NY 10016, USA
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Angelopoulos T, Moshel Y, Lu L, Torres L, Krey L, Grifo J. P-070. Correlation between semen parameters and maturity of normal human spermatozoa as assessed by Acridine Orange staining. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Angelopoulos T, Krey L, McCullough A, Adler A, Grifo J. P-028. A morphological and cytogenetic study of the germinal cells in male cancer patients. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.133-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barros A, Sousa M, Angelopoulos T, Tesarik J. Efficient modification of intracytoplasmic sperm injection technique for cases with total lack of sperm movement. Hum Reprod 1997; 12:1227-9. [PMID: 9222006 DOI: 10.1093/humrep/12.6.1227] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A rapid, simple and efficient method for selecting living spermatozoa for intracytoplasmic sperm injection (ICSI) in cases with total lack of sperm movement is described. The selection is based on a characteristic deformation of living spermatozoa exposed to hypo-osmotic conditions during short sequential exposures to modified culture medium and polyvinylpyrrolidone solution; the osmolarity of both of these solutions is reduced by one half by diluting them with an equal amount of water. The application of the sperm viability selection step in six ICSI treatment cycles with total absence of sperm movement resulted in a fertilization rate of 41.9% and the establishment of two ongoing clinical pregnancies. The method described for the selection of living spermatozoa makes it possible to reach acceptable fertilization rates and to obtain ongoing pregnancies by ICSI in cases with total lack of sperm movement. Because of its simplicity, this method can easily be improvised when the total lack of sperm movement is an unexpected finding made on the day of the planned ICSI.
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Affiliation(s)
- A Barros
- Laboratory of Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, University of Porto, Portugal
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Angelopoulos T, Krey L, McCullough A, Adler A, Grifo J. P-027. A simple and objective approach to identifying human round spermatids. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Angelopoulos T, McCullough A, Adler A, Grifo J. O-063 Occurrence and identification of round spermatids in ejaculates and testicular biopsies of azoospermic men. Fertil Steril 1997. [DOI: 10.1016/s0015-0282(97)90695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Angelopoulos T, Moshel Y, Lu L, Macanas E, Krey L. P-142 Swim-up and percoll density gradient separation of mature spermatozoa assessed by acridine orange (AO) staining. Fertil Steril 1997. [DOI: 10.1016/s0015-0282(97)90957-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Robertson R, Goss F, Michael T, Moyna N, Gordon P, Visich P, Kang J, Angelopoulos T, Dasilva S, Metz K. Validity of the Borg perceived exertion scale for use in semirecumbent ergometry during immersion in water. Percept Mot Skills 1996; 83:3-13. [PMID: 8873165 DOI: 10.2466/pms.1996.83.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This investigation examined the validity of the Borg 15-category Ratings of Perceived Exertion (RPE) scale during semirecumbent exercise in 32 degrees C water. 9 men undertook 12 8-min. trials at 3 power outputs and 4 pedal-crank rates. The power output was distributed between the arms (20%) and legs (80%). RPEs were measured for the arms, legs, chest, and over-all body. Correlation coefficients for RPE expressed as a function of power output and gross metabolic efficiency (MEG) ranged from .56 to .83 and .54 to .70, respectively, for each pedal-crank rate. Validity coefficients were greatest at those pedal-crank rates having the highest MEG. The Borg 15-category RPE scale is valid for use during semirecumbent exercise in water.
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Affiliation(s)
- R Robertson
- Department of Health and Physical Education, University of Pittsburgh, PA 15261, USA.
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Robertson R, Goss F, Michael T, Moyna N, Gordon P, Visich P, Kang J, Angelopoulos T, Dasilva S, Metz K. Metabolic and perceptual responses during arm and leg ergometry in water and air. Med Sci Sports Exerc 1995; 27:760-4. [PMID: 7674882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This investigation determined metabolic (i.e., kcal.min-1) responses and ratings of perceived exertion (RPE) for varying pedal-crank rates (PCR) and power outputs (PO) during arm and leg exercise in thermoneutral air (TA) and water (TW). Nine males (age 28.2 yr; leg cycle VO2peak 3.4 l.min-1) undertook the 24 exercise trials. During the TW trials kcal.min-1 were less (P < 0.05): at 50 W for 40 (X +/- SE; 10.9 +/- 0.8) than 50 (8.2 +/- 0.2), 60 (8.2 +/- 0.6), or 70 (7.4 +/- 0.3) rev.min-1 and at 100 W for 40 (15.2 +/- 0.7), 50 (14.0 +/- 1.1), and 60 (13.8 +/- 0.7) than 70 (12.1 +/- 0.5) rev.min-1. All other comparisons of kcal.min-1 between PCR at the three PO were not significant. During the TA trials kcal.min-1 were less (P < 0.05): at 50 W for 40 (11.4 +/- 0.3) than 60 (9.7 +/- 0.4) and 70 (9.1 +/- 0.4) rev.min-1 and for 50 (11.0 +/- 0.5) than 70 rev.min-1. During the TW trials: RPE-Arms and RPE-Overall at 50 W were lower (P < 0.05) for 40 (8.1 +/- 0.5; 8.3 +/- 0.4) than 60 (9.6 +/- 0.5; 9.8 +/- 0.6) and 70 (9.3 +/- 0.5; 9.9 +/- 0.7) rev.min-1, RPE-Legs at 50 W was lower (P < 0.05) for 40 (8.3 +/- 0.4) than 70 (9.9 +/- 0.7) rev.min-1. All other comparisons of RPE between PCR at the three PO were not significant.
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Affiliation(s)
- R Robertson
- Department of Health and Physical Education, University of Pittsburgh, PA 15261, USA
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Edwards NA, Wood CA, Stewart CJ, Tzelatis P, Angelopoulos T, Mignogna R. 545 RELAXATION EFFECTS OF ACUTE EXERCISE BY VARYING INTENSITY. Med Sci Sports Exerc 1990. [DOI: 10.1249/00005768-199004000-00545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Angelopoulos T, Robertson R. EFFECT OF REPEATED EXERCISE ON HDL-c, HDL2 AND HDL3. Med Sci Sports Exerc 1986. [DOI: 10.1249/00005768-198604001-00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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