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The presence of pesticide residues in groundwater, many years after their phase out in European Union verifies that the persistence in aquifer is much higher than in other environmental compartments. Currently used and banned pesticides were monitored in Northern Greece aquifers and a human health risk assessment was conducted. The target compounds were the herbicides metolachlor (MET), terbuthylazine (TER), atrazine (ATR) and its metabolites deisopropylatrazine (DIA), deethylatrazine (DEA) and hydroxyatrazine (HA). Eleven sampling sites were selected to have representatives of different types of wells. Pesticides were extracted by solid-phase extraction and analyzed by liquid chromatography. MET was detected in 100% of water samples followed by ATR (96.4%), DEA and HA (88.6%), DIA (78.2%) and TER (67.5%). ATR, DIA, DEA, HA, MET and TER mean concentrations detected were 0.18, 0.29, 0.14, 0.09, 0.16 and 0.15 μg/L, respectively. Obtained results were compared with historical data from previous monitoring studies and temporal trends were assessed. Preferential flow was the major factor facilitating pesticide leaching within the month of herbicide application. Moreover, apparent age of groundwater and the reduced pesticide dissipation rates on aquifers resulted of long-term detection of legacy pesticides. Although atrazine had been banned more than 18 years ago, it was detected frequently and their concentrations in some cases were over the maximum permissible limit. Furthermore, human health risk assessment of pesticides was calculated for two different age groups though drinking water consumption. In all examined wells, the sum of the HQ values were lower than the unity. As a result, the analyzed drinking water wells are considered safe according to the acute risk assessment process. However, the presence of atrazine residues causes concerns related with chronic toxicity, since ATR R values were greater than the parametric one of 1 × 10−6 advised by USEPA, for both age groups.

Several new implant devices have recently been introduced to glaucoma surgery using various techniques for reducing intraocular pressure (IOP). Two implants introduced during the past couple of years, XEN45 and PreserFlo Microshunt, are both designed to control subconjunctival filtration. There are two Swiss multicenter studies that collected the data retrospectively to analyze the efficacy and safety of these two devices separately. In this study, we report the analysis of the combined data subset from the University Hospital of Basel.The XEN45 implantation technique was introduced to Basel University Hospital in 2016 and PreserFlo Microshunt in 2018. Sixty operated patients, thirty in each group, were operated on by one surgeon, clinically followed up, and their data retrospectively analyzed from medical records. Only standalone procedures, without combined phacoemulsification, were considered in this analysis; the lens status, however, was neither an inclusion nor an exclusion criterion. Further inclusion criteria were the diagnosis of open-angle glaucoma, no previous glaucoma surgery, other than laser trabeculoplasty, and complete medical records during the 12 months of follow-up. IOP reduction during a 12-month postoperative period was the primary outcome measure as well as the number of IOP reducing drugs. The number of subsequent surgical interventions and complications/adverse events are descriptively reported.Patient age, gender, ophthalmological diagnosis, and initial preoperative IOP were well balanced between the two groups. Postoperative IOP course was comparable between the two methods for the first 12 months. IOP measurements were taken preoperatively and then on the first postop day, week 1, month 1, and months 3, 6, and 12 for the PreserFlo Microshunt vs. XEN45 (mmHg): 23.6 vs. 24.9, 9.0 vs. 8.9, 11.4 vs. 10.6, 13.0 vs.18.3, 16.8 vs.15.1, 15.9 vs.15.0, and 15.4 vs.14.5, respectively. IOP reducing medications were also comparable between the two groups. The study showed that subsequent interventions were more frequent in the XEN45 (13) than in the PreserFlo Microshunt group (7).Both methods demonstrate satisfactory IOP control within a 12-month postoperative period with practically no serious adverse events/complications, but with relatively high numbers of subsequent interventions (needlings), particularly in the XEN45 group.In den letzten Jahren haben einige neue Glaukomimplantate den Weg auf den Markt und in die Augenkliniken gefunden, mit unterschiedlicher Methodik zur Augendrucksenkung (IOD-Senkung). Zwei dieser Implantate, XEN45 und PreserFlo Microshunt, leiten die Kammerflüssigkeit subkonjunktival ab. Zwei voneinander unabhängige, multizentrische Schweizer Studien befassen sich mit der Effizienz und Sicherheit dieser beiden Methoden. Diese Erhebung berichtet über die Zwischenergebnisse einer retrospektiven Subanalyse, welche die Daten beider Methoden vom Augenspital Basel kombiniert.XEN45-Implantationstechnik wurde in Basel 2016, PreserFlo Microshunt 2018 eingeführt. 60 Patienten wurden von einem Chirurgen operiert, danach klinisch nachkontrolliert und ihre Daten retrospektiv via Aktenstudium analysiert. Es wurden Patienten mit Glaukomoperationen ohne Kombination mit einer Kataraktoperation berücksichtigt; der Linsenstatus (phak/pseudophak) war weder Einschluss- noch Ausschlusskriterium. Einschlusskriterien waren die Diagnose eines Offenwinkelglaukoms, keine vorausgegangene Glaukomchirurgie, außer der Lasertrabekuloplastik, und vollständige klinische Patientenakten während der ersten 12 postoperativen Monate. In den Subgruppen wurden die konsekutiven Daten von jeweils 30 Patienten, welche die o. g. Kriterien erfüllt hatten, eingeschlossen. Analysiert wurden die postoperativen IOD-Werte, Anzahl der drucksenkenden Medikation und die eventuellen nachfolgenden Interventionen.Alter, Geschlechterverteilung, Augendiagnosen und präoperativer IOD waren vergleichbar zwischen den beiden Interventionsgruppen – ebenso wie der postoperative IOD-Verlauf in beiden Gruppen. Die IOD-Werte in mmHg präoperativ/am 1. postoperativen Tag/Woche 1/Monate 1/3/6/12 waren jeweils für PreserFlo Microshunt und XEN45 wie folgt: 23,6 vs. 24,9; 9,0 vs. 8,9; 11,4 vs. 10,6; 13,0 vs. 18,3; 16,8 vs.15,1; 15,9 vs. 15,0; 15,4 vs. 14,5. Die Anzahl der IOD-senkenden Medikamente war postoperativ zwischen den 2 Gruppen ausbalanciert; die Anzahl der nachträglichen Interventionen war höher in der XEN45- (13) als in der PreserFlo-Microshunt-Gruppe (7).Beide Methoden haben während des Beobachtungszeitraums von 12 Monaten eine gute Kontrolle des Augendrucks mit wenigen Nebenwirkungen erbracht. Eine Anzahl an kleineren, nachträglichen Interventionen (Needlings) war in beiden Gruppen notwendig, insbesondere in der XEN45-Gruppe.

The presence of pesticide residues in groundwater, many years after their phase out in European Union verifies that the persistence in aquifer is much higher than in other environmental compartments. Factors such as limited degradation, and adsorption in phreatic horizon have resulted in frequent detection of pesticide residues and their metabolites in the saturated zone. Currently used and banned pesticides were monitored in Northern Greece aquifers and risk to human health was assessed. The target compounds were the herbicides metolachlor, terbuthylazine, atrazine and its metabolites Deisopropylatrazine (DIA), Deethylatrazine (DEA) and Hydroxyatrazine (HA). The area’s aquifer has been extensively studied over the past 20 years. Eleven sampling sites were selected in order to have representatives of different type of wells. Namely, five drinking water, two irrigation wells and four experimental boreholes located close to Greek/Turkish/Bulgarian borders were monitored and fifty-four samples were analyzed. Pesticides were extracted by solid-phase extraction and analyzed by liquid chromatography. Metolachlor was detected in 100% of water samples followed by ATR (96.4%), DEA and HA (88.6%), DIA (78.2%) and TER (67.5%). Atrazine, DIA, DEA, HA, MET and TER mean concentrations detected were 0.18, 0.29, 0.14, 0.09, 0.16 and 0.15 μg/L, respectively. Obtained results were compared with historical data from our previous monitoring studies (1999-2003 and 2010-2012) and temporal trends were assessed. Preferential flow was the major factor facilitating pesticide leaching within the month of herbicide application. Moreover, apparent age of groundwater and the reduced pesticide dissipation rates on aquifers resulted of long-term detection of legacy pesticides. Although atrazine had been banned more than 15 years ago, it was detected frequently during our monitoring campaign and their concentrations in some cases were over the maximum permissible limit. Furthermore, human health risk assessment of pesticides was calculated for two different age groups though drinking water consumption. The presence of atrazine residues causes concerns related with chronic toxicity.

Suicidal behavior occurs at much higher rates in correctional facilities than in the community, yet little is known about factors that distinguish inmates at risk for attempting versus dying by suicide. Individuals in the current study included 925 inmates housed in 2 large U.S. jails and 8 state correctional systems who attempted (79.5%) or died by (20.5%) suicide for whom archival data were available. Mental health professionals completed a tracking sheet after suicide-related incidents, documenting inmate psychological, diagnostic, and treatment related risk factors. Differences between inmates who attempt versus those who die by suicide indicate that when mental health staff are aware of inmates' current and historical risk factors, deaths by suicide are less likely to occur. (PsycINFO Database Record

Constructed wetlands (CWs) and biopurification systems (BPS) present two low-cost approaches for the removal of pesticides from waters of agricultural origin. Both strategies were tested in the treatment of the herbicide terbuthylazine, a triazine of worldwide use. Three horizontal subsurface flow (HSF) CW systems were operated continuously for one year; the planted CWs (containing either Phragmites australis or Typha latifolia) were able to remove up to 73.7% and 58.4% of the pesticide, respectively, and exhibited a markedly superior performance compared to the unplanted CW. However, by the end of the treatment period, some symptoms of phytotoxicity were observed in the plants of the CWs, which are related to high terbuthylazine concentrations in plant material. A coconut fiber-containing biomixture was used in BPS which was able to rapidly remove terbuthylazine, with an estimated half-life of 8.1 d, the fastest so far reported in these systems. However, the biomixture failed to detoxify the matrix, according to ecotoxicological tests of seed germination. The current data suggests that coupled/hybrid configurations comprising CWs and BPS in series could provide increased effectiveness and a low-cost technology to remove terbuthylazine from highly contaminated water.

Field and pot trials were conducted in two sites of northern Greece (Thermi and Lepti) to study selectivity and weed control in maize (Zea mays L.) with herbicide mixtures based on tembotrione. Treatments included tembotrione (plus isoxadifen-ethyl safener) applied alone at 100 g ai/ha and three mixtures of tembotrione with: (i) rimsulfuron at 10 g ai/ha, (ii) nicosulfuron at 40 g ai/ha and (iii) foramsulfuron at 60 g ai/ha (label rates for weed control in maize). Herbicides were applied at the 7- to 8-leaf growth stage of maize in Thermi and at the 6- to 7-leaf growth stage in Lepti. Six weeks after treatment, control of rhizomatous Sorghum halepense with tembotrione alone was 63% in Thermi and 60% in Lepti, with plants showing the typical bleaching symptoms of the HPPD-inhibiting herbicides. Control of rhizomatous S. halepense with the mixtures was improved from 63% to 86% in Thermi and from 60% to 82% in Lepti compared with the single treatment of tembotrione, with plants showing only the sympt...

Intracorneal ring segment (ICRS) implantation represents a modern, minimally invasive, surgical option for visual improvement in patients with keratoconus. ICRS modify the corneal geometry in a manner that enhances its refractive properties and thereby, they improve visual acuity. It is well-documented that implantation of ICRS decreases the keratometric readings, spherical equivalent and cylinder, reduces high-order aberrations and improves uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCDVA) in patients with keratoconus. Success rate after ICRS implantation is high, depending on appropriate patient selection and adherence to suitable implantation nomograms, and most important, the overall complication rate is very low. This review is summarizing current indications/contra-indications for ICRS implantation, implantation techniques, clinical outcomes and potential complications, shedding light on myths and realities related to this innovative surgical option.

Background The impact of Body Mass Index (BMI) on efficacy of TNF blocking therapy in Rheumatoid Arthritis (RA) patients and therefore on control of the disease is an important question. Objectives The aim of this study is to determine the influence of BMI on the efficacy of TNF blocking therapy in terms of disease activity in patients with RA. Methods A retrospective, observational study of 168 consecutive RA patients who received subcutaneously (SC) TNF blocking treatment (adalimumab, etanercept, golimumab and certolizumab pegol). Their follow-up data, for at least 26 weeks, and their baseline BMIs were available. The WHO definition for normal weight, overweight and obesity was applied, whereas clinical response was compared by BMI subgroups. Results The average BMI was 26.83±4.34 kg/m 2 and the baseline Disease Activity Score in 28 joints (DAS28 [ESR]) was high at 5.72±0.84. Mean age was 63.47±12.58 years and 135 (80.36%) were female. The median disease duration was 13.01±8.57 years. Overall, patients with normal weight responded better to treatment regimen, followed by overweight and obese subgroups. After a follow-up period of 26 weeks, the obese group had significantly higher DAS28 (ESR) and Health Assessment Questionnaire (HAQ) than either normal or overweight subgroups (3.26±0.84 vs 2.72±0.78 vs 2.81±0.82, p vs 0.076±0.01 vs 0.178±0.01, p p :0.002 and normal HAQ (≤0.5) p : 0.003. Conclusions Patients with RA and higher BMIs demonstrated a diminished clinical response after 26 weeks of SC-administered TNF-blocking treatment compared with their counterparts with lower BMIs. References [1] Klaasen R1, et al. Body mass index and clinical response to infliximab in rheumatoid arthritis. Arthritis Rheum2011Feb;63(2):359–64. [2] Puig L1. Obesity and psoriasis: body weight and body mass index influence the response to biological treatment. J Eur Acad Dermatol Venereol2011Sep;25(9):1007–11. [3] Daien CI1, et al. Predictive factors of response to biological disease modifying antirheumatic drugs: towards personalized medicine. Mediators Inflamm2014;2014:386148. [4] Schulman E1, et al. Overweight and Obesity Reduce the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort Study. Arthritis Care Res (Hoboken)2017Nov 30. Disclosure of Interest None declared

Summary Common burdock (Arctium minus) is a common biennial weed of non-arable land in typical rural settings of Orestiada, Greece. The aim of this study was to describe the basic morphological traits of this species throughout the main phenological stages of its life cycle and to obtain some insight into its growth and productivity in Orestiada. Based on our observations, the plants occurred most commonly in moist and fertile soils, usually as isolated individuals or in small patches near the parent plants. The species is characterized by its large basal ‘elephant-ear’ leaves during the vegetative stage, appearing in alternate arrangement, with irregularly wavy and non-toothed edges, as well as with long hollow stalks forming a noticeable furrow on the top. By monitoring individual plants, it was found that fl owering (in the second year of growth) mostly occurred from late June up to early August. The fl owers were purple, occurring in bristly heads at the top of the stem. The bristly heads formed a fruit, containing small black seeds. The average number of capitula per plant, from randomly selected populations in Orestiada, was found to be 69.7 and 57.7 respectively, whereas the mean seed number per capitulum reached 30.3 and 33.3 seeds, respectively

Background Several risk factors for contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) have been identified. The cumulative effect of these risk factors on renal function has been assessed with the development of risk score models in a number of studies. However, concerns were raised that estimates of the risk attributable to individual factors may be unreliable. We sought to develop a simple risk score for developing CIN after PCI irrespective of use of prophylactic measures and also capturing the effect of pre-intervention medication and presence of various co-morbidities. Methods Consecutive patients treated with elective or urgent PCI at our cardiac catheterization laboratory were enrolled (derivation cohort n=488, validation cohort n=200). CIN was defined as increase ≥25% and/or ≥0.5mg/dl in serum creatinine at 48h after PCI vs baseline. Multivariable logistic regression analysis was then performed to identify independent predictors of CIN (pre-existing renal disease, metformin use, history of previous PCI, peripheral arterial disease and ≥300ml of contrast volume). Results The incidence of CIN in the development cohort was 10.2% with a significant trend across increasing score values (p Conclusions The proposed risk score is easily applicable and allows for practically simple risk assessment compared to other published scores while at the same time overcomes drawbacks of previous model designs.

Hereditary angioedema is a rare genetic disorder resulting from an inherited deficiency or dysfunction of the C1-esterase inhibitor of the classic complement pathway. It is characterised by recurrent episodes of angioedema, without urticaria or pruritus, most often affecting the skin or the mucosal tissues of the upper respiratory and gastrointestinal tracts. We describe the peri-operative care of a woman with hereditary angioedema undergoing laparoscopic cholecystectomy with emphasis on the role of anaesthetists as peri-operative physicians.

Arrhythmogenic right ventricular dysplasia, also called right ventricular cardiomyopathy, is a genetically determined heart muscle disease, characterised by life-threatening ventricular arrhythmias in apparently healthy young people. The primary myocardial pathology is that the myocardium of the right ventricular free wall is replaced by fibrous or fibrofatty tissue, with scattered residual myocardial cells. Right ventricular function is abnormal and in severe cases is associated with global right ventricular dilation and overt biventricular heart failure. Although still relatively rare, arrhythmogenic right ventricular cardiomyopathy is a well recognised cause of sudden unexpected peri-operative death. In this review, we describe the basic characteristics of this disease, emphasising the diagnosis and we offer some suggestions for the anaesthetic management of these patients in the peri-operative period.

Several risk factors for contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) have been identified. The cumulative effect of these risk factors on renal function has been assessed with the development of risk score models in a number of studies. However, concerns were raised that estimates of the risk attributable to individual factors may be unreliable. We sought to develop a simple risk score for developing CIN after PCI irrespective of use of prophylactic measures and also capturing the effect of pre-intervention medication and presence of various co-morbidities.Consecutive patients treated with elective or urgent PCI at our cardiac catheterization laboratory were enrolled (derivation cohort n = 488, validation cohort n = 200). CIN was defined as increase ≥ 25% and/or ≥ 0.5 mg/dl in serum creatinine at 48 h after PCI vs baseline. Multivariable logistic regression analysis was then performed to identify independent predictors of CIN (pre-existing renal disease, metformin use, history of previous PCI, peripheral arterial disease and ≥ 300 ml of contrast volume).The incidence of CIN in the development cohort was 10.2% with a significant trend across increasing score values (p0.001). The model demonstrated good discriminating power (c-statistic 0.759) and excellent calibration (calibration slope 0.91). The model was validated internally by bootstrapping in 1000 samples (c-statistic 0.753) and in a cohort of 200 patients (c-statistic 0.864) demonstrating stable performance.The proposed risk score is easily applicable and allows for practically simple risk assessment compared to other published scores while at the same time overcomes drawbacks of previous model designs.

An approach combining monitoring and ecotoxicological data has been undertaken to assess pesticide loading in the drainage canals of two transboundary rivers of northeastern Greece near the Greek/Bulgarian/Turkish borders as well as the subsequent risk to non-target aquatic organisms. Aquatic risk assessment was based on the Risk Quotient (RQ=MEC/PNEC) regarding three trophic levels, algae, aquatic invertebrates and fish. Alachlor, atrazine, carbaryl, carbofuran, cypermethrin, DEA, DIA, diazinon, dimethoate, endosulfan, metolachlor, monilate, prometryn and trifluralin were the compounds detected at the highest concentrations on a regular basis. Extreme concentrations were observed just after high rainfall events during the month of pesticide application. Aquatic risk assessment revealed non-acceptable risk for 10 compounds when median concentrations were used as ΜEC values. However, should extreme concentrations be taken into account, 15 compounds were considered as likely to pose a threat to aquatic organisms. Conformity to EC environmental quality standards is also discussed.

Hereditary angioedema is a rare genetic disorder resulting from an inherited deficiency or dysfunction of the C1-esterase inhibitor of the classic complement pathway. It is characterised by recurrent episodes of angioedema, without urticaria or pruritus, most often affecting the skin or the mucosal tissues of the upper respiratory and gastrointestinal tracts. We describe the peri-operative care of a woman with hereditary angioedema undergoing laparoscopic cholecystectomy with emphasis on the role of anaesthetists as peri-operative physicians.

The present paper is an interesting and rare complication of implantation of a permanent pacemaker lead. The rarity of the case is based upon that ventricular perforation is usually present during implantation, whereas in our case, it was presented late--1 month after implantation. Furthermore, in our case, the pacemaker lead had migrated through the left hemidiaphragm into the peritoneal cavity.

A monitoring study of 147 compounds in surface river waters from northeastern Greece near Greek/Bulgarian/Turkish borders was carried out during 1999-2007. Based on agricultural use eight sampling points along the rivers Ardas, Evros and Erythropotamos were set up, covering the distance from the Greek/Bulgarian borders down to the river's discharge (river's delta) in the Greek territory. In total, 88 sampling events were carried out from 1999 to 2007. Pesticides were extracted by solid-phase extraction (SPE) and analyzed by gas chromatography-mass spectrometry (GC-EI-MS) using a multiresidue in-house analytical method including pesticides belonging to different chemical classes. Aquatic risk concerning the detected pesticides was assessed on the basis of the risk quotient (RQ = PEC/PNEC). From the 28 compounds (pesticides, metabolites and caffeine) that were detected in surface waters of northeastern Greece the soil applied pesticides were the most frequently detected. High pesticide concentrations were detected within 2 months of their application. Extreme pesticide concentrations were detected in the beginning of the irrigation season or just after high rainfall events. Generally, low levels of pesticide residues were found in the first sampling point (Greek/Bulgarian borders) of all rivers, however o',p' DDT, o',p' DDE and gamma-HCH were mainly detected in this sampling point regarded as cross-boundary contamination. The most commonly encountered compounds in the river waters were atrazine, DEA, alachlor, trifluralin, prometryne, molinate, carbofuran, carbaryl and diazinon. Increased loading (primary as well as secondary peaks) seemed to be a consequence of application (timing, rate, frequency) and intense rainfall during the application period. Aquatic risk assessment revealed that from the 28 compounds that were constantly detected 12 showed non-acceptable risk when median concentrations were used as PEC and 18 when extreme concentrations were used as PEC values.

A 67-year-old man presented to the emergency department, reporting a first episode of light-headedness and palpitations upon standing up that morning. The patient had a history of hypertension, treated with carvedilol and lacidipine. He …