Aristotle University of Thessaloniki

Aims This report, from the International Consultation on Incontinence‐Research Society, aims to evaluate the existing evidence and identify diagnostic and treatment gaps for Lower Urinary Tract Symptoms (LUTS) in post‐menopausal women with Genitourinary Syndrome of Menopause (GSM). Methods An overview on the current literature, including pathophysiology, diagnosis and management of GSM associated LUTS, including incontinence, overactive bladder, underactive bladder and recurrent urinary tract infections (rUTIs). Results Significant gaps in the literature were identified. GSM is underdiagnosed and the interplay between hormonal changes in the postmenopausal period on LUTS remains poorly understood. Diagnostic methods for rUTIs lack sensitivity and the role of the urinary microbiome is emerging. Current treatments, including topical oestrogens and systemic hormone therapy, lack long‐term efficacy data on LUTS. Evidence for regenerative medicine techniques remain limited by low‐quality studies and short‐term follow up. Conclusion There is lack of high‐quality evidence, which hinders the optimal management of LUTS in post‐menopausal women with GSM. The panel proposes targeted research questions, focusing on the hormonal impact on the lower urinary tract, advancing diagnostics and robust clinical trials for existing and novel therapies, to bridge current gaps in the literature and improve patient care.

In this work, the use of false chaotic attractors in enhancing the security of chaos-based encryption applications will be explored. False attractors result from rearranging the solution trajectories of a nonlinear dynamical system, leading to novel shapes in the 3D space. This way, a single solution trajectory of a chaotic system can be used to generate numerous new false trajectories. Examples of such attractors are provided for the Lorenz system, and a system with line equilibrium from Moysis et al (2019). By formalizing the method of constructing false attractors, and generalizing it by adding a series of elementary operations, the key parameters of this procedure can be used as part of the secret key in symmetric encryption applications, effectively increasing the key space. Specifically, the key space increases significantly with respect to the simulation time, and the system’s dimension. Moreover, due to its fast implementation, this technique can be used as a less complex, but much lighter alternative to full scale permutation. The usability of the false attractors as sources of randomness is showcased through the design of a chaotic pseudo-random bit generator. The generator can output 64 bits per iteration, and is equally effective under any false attractor of the chaotic system.

Aims The optimal short-term antithrombotic strategy following left atrial appendage occlusion (LAAO) remains uncertain, with the need to balance thromboembolic prevention and bleeding risk presenting a critical challenge. Recent evidence suggests that direct oral anticoagulants (DOACs) may provide a favourable safety–efficacy profile, with low-dose regimens showing potential benefits during the device endothelialization period. This network meta-analysis (NMA) aimed to compare the efficacy and safety of various antithrombotic strategies, including DOAC dosing, following LAAO. Methods and results A systematic review and NMA were conducted following Cochrane and PRISMA guidelines. Eligible studies included randomized controlled trials (RCT) and observational studies comparing at least two antithrombotic regimens in patients with non-valvular atrial fibrillation undergoing percutaneous LAAO. Primary outcomes were major bleeding and thromboembolism. Secondary outcomes included device-related thrombosis (DRT) and all-cause mortality. Pairwise and network meta-analyses were performed using a random-effects model. A total of 52 studies (49 observational and 3 RCTs) involving 69 751 patients were included. DOACs were consistently associated with significantly lower rates of major bleeding and all-cause mortality than other antithrombotic regimens. Low-dose DOACs showed a potential advantage over standard-dose DOACs in reducing major bleeding risk (odds ratio 0.45, 95% confidence interval: 0.22–0.92). For thromboembolism and DRT, standard-dose DOAC significantly reduced risk compared with single antiplatelet therapy (SAPT) but not with dual antiplatelet therapy (DAPT), whereas low-dose DOAC significantly reduced both outcomes compared with SAPT, DAPT, and vitamin K antagonists plus SAPT. In ranking analysis, DOACs emerged as the most effective and safest antithrombotic strategy, with low-dose DOACs demonstrating further safety benefits in bleeding outcomes. Conclusion DOACs provide a superior safety–efficacy profile compared with other antithrombotic strategies following LAAO, significantly reducing the risks of major bleeding, thromboembolic events, and mortality. While low-dose DOACs may offer additional bleeding risk reduction without compromising efficacy, further research is warranted to confirm their role in clinical practice.

This study explores how preschool-aged children perceive, reproduce, and emotionally experience gender in everyday life, through the use of photovoice and semi-structured interviews. Drawing on a phenomenological approach informed by postmodern feminist theory, the research centers children’s voices and meaning-making processes as they navigate the social codes of masculinity and femininity. Eleven children aged 4 to 6 participated by capturing and discussing photographs that represented their understanding of gender in everyday life. The thematic analysis revealed how children internalize dominant gender norms, such as color coding, toy preferences, and emotional expression, while also demonstrating moments of questioning and resistance. Gendered meanings were embodied and affectively charged, with boys showing more constraints around emotional expression and girls negotiating space within normative boundaries. The findings emphasize the interplay between cultural symbols, emotional investments, and social relationships in shaping young children’s gender identities. This research highlights the need for early childhood environments that support more fluid, inclusive understandings of gender and promote children’s agency in expressing their identities.

Background COVID‐19 control measures have had a unique impact on people with dementia (PWD) and their carers living at home. Yet, uncertainty exists regarding the global impact of such measures and whether differences exist between countries and global regions. We aimed to synthesize evidence on this topic. Methods We searched Medline, PsycINFO, EMBASE, Web of Science, CINAHL, Latin American and Caribbean Health Literature (LILACS), Scientific Electronic Library Online (SciELO), and EM Premium from the start of the pandemic to July 2022. At least two researchers independently screened citations and performed quality assessment following recommended criteria for critical appraisal according to study methodology. We analyzed data by country and region and synthesized results descriptively. Results Sixty‐nine studies met inclusion criteria (74% quantitative and 26% qualitative; 22% included PWD, 44% carers of PWD, and 4% dyads), with a total of 209,738 participants. Most studies were conducted in Europe (59%), followed by Asia and North America (15% each), South America (7%), and Oceania (1%). Two studies presented data from multiple regions (3%). The quality of the studies varied, with the majority (62%) being of moderate quality. Across the study populations and global regions, COVID‐19 control measures had implications for PWD and carers’ access to health services, physical and mental health and daily routine, cognition, behavior, with accompanying social and economic costs. The impact on mental health for PWD and on loneliness and well‐being for carers were the two most frequently studied outcomes. Conclusion People with dementia and their carers represent a heterogeneous group of people across countries and communities; despite that, the impacts of COVID‐19 control measures on PWD and their carers were broadly consistent across regions. Our evidence synthesis highlights the critical need for decision‐makers to account for the needs of PWD and their carers when designing and implementing public health measures. Other This work was funded by the JPND Call for Expert Working Groups: The Impact of COVID‐19 on Neurodegenerative Diseases in partnership with the CIHR‐Institute of Aging and the Public Health Agency (CIHR #02342‐000). PROSPERO CRD42024554701.

We correct a mistake found in our the article “Cesàro-like operators acting on spaces of analytic functions”, published in Anal. Math. Phys. 12 (2022), no. 2, Paper No. 51, 29 pp.

In this short review, the multiscale modeling of dissipative composites undergoing fully coupled thermomechanical processes is outlined through the models presented in a collection of recent works. The aim is to demonstrate the challenges and limitations of: (1) the multiscale approaches (full-field or mean-field techniques), (2) the computational approaches dealing with complex material systems, (3) the alternative methodologies dedicated to the analysis of composite structures, such as those founded on the data-driven modeling and the model order reduction techniques.

Objective The aim of this systematic review was to assess the effect of metformin on anthropometric indices, hormones and adipocytokine concentrations in children with overweight or obesity. Methods Eligible studies were searched via PubMed, Scopus, Cochrane Central Register of Controlled Trials, alongside clinical trial registries and the reference lists of included studies, from inception to October 2024. Screening was carried out independently by two reviewers, involving title-abstract screening for relevance, followed by full-text review for eligibility confirmation. Data extraction was performed by two independent investigators using an identical Excel spreadsheet. A meta-analysis was conducted using the random-effects model. Results A total of 19 original studies were deemed eligible for this systematic review. Metformin was more effective than placebo in improving Body Mass Index (BMI), BMI-Z score, body weight, fasting insulin and leptin concentrations (mean difference (MD) −1.07 kg/m ² , 95% CI −1.62 to −0.52; MD −0.09, 95% CI −0.13 to −0.05; MD −3.20 kg, 95% CI −4.21 to −2.19; MD −3.38 μU/mL, 95% CI −6.00 to −0.75; MD −3.73 ng/mL, 95% CI −6.28 to −1.18, respectively). There was no difference between metformin and placebo on adiponectin and resistin concentrations, as well as adiponectin to leptin ratio. Conclusion Metformin may have a role as an adjuvant therapy in managing overweight and obesity among the paediatric population. Regarding the concentrations of adipokines and hormones, the results are inconclusive. More randomised controlled trials with rigorous methodology and homogeneity in population and intervention characteristics are needed to shed light on this topic. Trial registration number PROSPERO CRD42023401732.

Introduction Ulcerative colitis (UC) is a chronic inflammatory disease that impairs health-related quality of life (HRQoL). We evaluated the effect of approved therapies on HRQoL in adults with moderate-to-severe UC. Methods We systematically searched Medline, Embase, CENTRAL, and gray literature through December 2024 for randomized controlled trials of approved therapies. The primary outcome was change in Inflammatory Bowel Disease Questionnaire (IBDQ) score during induction and maintenance. Secondary outcomes included changes in Short Form-36 (SF-36) Mental and Physical Component Scores, Work Productivity and Activity Impairment in UC (WPAI-UC), and rates of IBDQ response (≥16-point increase) and remission (score ≥170). Minimal clinically important differences were prespecified. Subgroup analyses based on prior biologic exposure were performed for primary outcome. Frequentist random-effects network meta-analyses were conducted, and confidence in estimates was assessed using the CINeMA (Confidence In Network Meta-Analysis) framework. Results Twenty-eight RCTs were included; 26 reported HRQoL outcomes during induction and 15 during maintenance. During induction, clinically meaningful improvements in IBDQ were observed with upadacitinib, filgotinib, and guselkumab. During maintenance, upadacitinib 30 mg and vedolizumab showed HRQoL benefits, although clinical meaningfulness was not consistently demonstrated. SF-36 improvements were modest overall, with upadacitinib and vedolizumab showing selective advantages, while WPAI-UC benefits were observed with upadacitinib, vedolizumab, and ustekinumab. Upadacitinib consistently ranked highest in IBDQ response and remission, while other therapies showed variable efficacy across outcomes. Discussion Advanced therapies vary in their impact on HRQoL, with some demonstrating clinically meaningful improvements in UC. These findings support integrating HRQoL into treatment selection and shared decision-making.

Objective Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment but can cause several immune-related adverse events. Case reports and population-based studies have reported that ICI treatment may also be associated with higher incidence of fractures, but this has not been systematically studied. The aim of the study is to examine whether treatment with ICIs increases the incidence of fractures compared with chemotherapy or placebo. Methods and analysis Electronic databases (PubMed, Embase and Cochrane Library) were systematically searched for randomised controlled trials (RCTs), including an ICI monotherapy arm and a placebo/chemotherapy arm, published from database inception to December 2024. Only patients with solid tumours were included. The review protocol was registered in the PROSPERO database (CRD42023448831). Aggregated data were pooled for meta-analysis. The primary outcome was the incidence of clinical, non-pathological fractures in patients with solid cancer treated with ICIs compared with those treated with chemotherapy, placebo or no treatment. Risk of bias was evaluated with the Cochrane Risk of Bias V.2.0 tool. Results A total of 30 RCTs were identified involving 19 407 patients, of whom 10 076 were ICI users and 9331 non-ICI controls. Among 121 patients with fractures, 68 were ICI users and 53 non-ICI controls. compared with controls, ICI users had a non-significant 18% higher fracture incidence (OR 1.18, 95% CI 0.82 to 1.70). In the subgroup analysis, fracture incidence was 47% higher in ICI users compared with chemotherapy users (OR 1.47, 95% CI 0.93 to 2.32, n=19 studies) but 20% lower compared with placebo users (OR 0.80, 95% CI 0.44 to 1.48, n=10 studies). Conclusion Our analysis suggests an 18% increase in the incidence of clinical non-pathological fractures in ICI users compared with non-ICI controls, although with considerable uncertainty due to wide CIs. Given the small number of reported fractures in RCTs, continued research is warranted to monitor fracture incidence in this patient population. PROSPERO registration number CRD42023448831.

Sustainable consumption is crucial in addressing environmental challenges and promoting responsible production practices. Consumers have the power to drive the adoption of sustainable supply chains through their purchasing choices. Environmentally responsible consumption benefits the environment and incentivises producers to adopt sustainable practices. This study examines how sustainable consumption patterns in the European Union (EU) affect the design and management of sustainable supply chains. A survey of 3129 respondents from different EU regions and demographics gathered data on purchasing habits, product types, purchase frequency, and influencing factors. The data were statistically analysed using clustering to identify common consumption patterns and segments of similar behaviour. Their willingness to pay a premium for sustainable products and purchase intention were tested based on their net household income. The study found that sustainable consumption patterns are closely linked to sustainable supply chain management practices. The study provides valuable insights into the relationship between sustainable consumption patterns and supply chain management across the EU. Sustainable supply chains offer research opportunities for policy, production, and business. Adopting sustainable initiatives in supply chains faces significant barriers, with government support and policies being crucial. The findings can inform policies and strategies to promote sustainable consumption and responsible supply chain practices.

Effective water resources management is crucial for addressing challenges such as climate change, population growth, and increasing agricultural demands. Within the EWA-BELT project framework, the Thornthwaite-Mather method was employed to evaluate the water balance across selected watersheds in Ghana, Tanzania, Burkina Faso, and Kenya. This well-established method provides insight into the dynamic interactions among precipitation, evapotranspiration, and soil water storage over time within a specified geographic area. Comprehensive data—including land use, soil characteristics, geological conditions, GIS information (sourced from literature reviews and online platforms), and meteorological records (precipitation and temperature)—were integrated to calculate the water balance. The analysis highlighted distinct hydrological differences between East and West Africa. East African sites generally experience lower temperatures, higher precipitation, and more permeable geological formations. Key findings indicate that all studied basins exhibit a water surplus, with annual soil moisture reaching capacity, thereby storing excess water in aquifers and contributing to runoff. Notably, case studies in Kenya and Tanzania demonstrate a higher potential for water resource exploitation due to increased precipitation, higher infiltration rates, and relatively lower evapotranspiration compared to Ghana and Burkina Faso. Consequently, these regions may provide more water to meet human demands, particularly for irrigation. The method’s outputs offer valuable insights for water resource management, agricultural planning, and climate change impact assessments, particularly in regions where water availability is critically dependent on seasonal and inter-annual variations.

Over a decade since the official ending of the GOCE satellite mission (2009–2013), GOCE based gravity data continue to provide useful information to the study of the static gravity field of the Earth. The present study deals with the application of GOCE SGG wavelet multi-resolution analysis to the latest available Level 2 GOCE data, in order to be used for geoid and gravity field modeling applications. In total, three different methods of computing disturbing gravity gradients at satellite altitude were applied in this study, based on the latest EGG_NOM_2, SST_PSO_2 and EGG_TRF_2 products, as well as on information coming from Global Geopotential Models (GGMs). The EGG_NOM_2 and SST_PSO_2 derived gradients were then projected from the satellite altitude to a mean orbital sphere, with a special focus on the study area covering the wider Hellenic and Eastern Mediterranean regions. To the mean sphere projected disturbing gravity gradients exhibited still track-wise noise, so that a 2D Wavelet Multi-Resolution Analysis (WL MRA) using a Daubechies wavelet at 14 levels of decomposition was applied. Various reconstruction scenarios using different levels of decomposition were considered, corresponding to different spatial resolutions. The optimal one for our purposes was deemed to be the one using levels 7–14, corresponding to spatial resolutions from approximately 117 km onwards. The resulting filtered disturbing gravity gradient field are ready to be used in studies with different goals, as in the case of geodetic and geophysical works. Comparisons of the resulting mean fields using different synthesis scenarios are carried out, so as to gain insight on the spectral content of the various fields.

Rheumatoid arthritis (RA) is associated with elevated cardiovascular risk. Asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor and marker of endothelial dysfunction, has been implicated in inflammation-driven vascular injury. However, the association between ADMA and micro- and macrovascular function in RA remains unclear. Patients with RA underwent nailfold videocapillaroscopy (NVC) to assess microvascular alterations in the dermal capillary network. Macrovascular function was evaluated with well-known markers of arterial stiffness [carotid–femoral pulse wave velocity (PWV), augmentation index], and subclinical atherosclerosis [carotid intima–media thickness]. Serum ADMA was measured using enzyme-linked immunosorbent assay (ELISA). A total of 103 consecutive RA patients (61.1 ± 11.6 years, 76.7% female) were studied with median disease duration 6 (12) years. Patients were under methotrexate (54.4%), corticosteroids (35.9%) and biologics (38.8%). A considerable portion had been previously diagnosed with hypertension (38.8%) and dyslipidemia (31.1%), and 41.7% were smokers. ADMA was not significantly associated with cardiovascular risk factors or markers of vascular injury in the total cohort. However, in the subgroup of patients not receiving cardiovascular medication (n = 48), ADMA significantly correlated with PWV, venous limb diameter and capillary tortuosity, even after adjustment for other variables in multivariate analysis. Circulating ADMA was not associated with markers of vascular impairment in a real-life RA cohort presenting with various treatments and comorbidities. However, ADMA independently correlated with arterial stiffness and NVC abnormalities in the subgroup of RA patients not on cardiovascular medications. These findings are consistent with a role of impaired NO homeostasis in vascular injury in RA. Key Points • This study is the first to investigate the association between circulating ADMA levels and both micro- and macrovascular injury in rheumatoid arthritis using nailfold videocapillaroscopy and markers of arterial stiffness and subclinical atherosclerosis. • Significant correlations between ADMA, pulse wave velocity, and nailfold videocapillaroscopic abnormalities were observed in patients not receiving cardiovascular medications. • These findings suggest that impaired nitric oxide metabolism may contribute to peripheral microangiopathy and vascular dysfunction in rheumatoid arthritis.

Solution-processable organic light emitting diodes (OLEDs) are emerging as the most promising next-generation lighting technology. However, the up-scaling and the roll-to-roll production of this solid-state lighting technology remain a great challenge up to this day. One of the key factors that determines the performance of an OLED device is the balanced and effective injection/transport of charge carriers from the electrodes to the emitting layer. Injection and transport of carriers can be significantly affected by internal factors such as the energy-level alignment and the integrity of the interfaces formed between the individual thin films of the stacked architectures of the devices. In this work, various charge transport layers, such as Poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS), Poly(9,9-dioctylfluorene- alt-N(4-sec-butylphenyl)-diphenylamine (TFB), Copper(I) thiocyanate (CuSCN) and Poly[9,9-dioctyl-9′,9′-bis[3-(trimethylamomonio)propyl][2,2′-bi-9 H-fluorene]-7,7′-diyliodide (PFN-I), are grown as thin films by spin coating and characterized. Following this, the fabrication of multilayer OLED devices was carried out for the comparative evaluation of the performance and functional properties. It was found that the energy level alignment of various functional layers, along with the morphological quality of the mixed interlayers between these layers, are strongly correlated with the accumulation and trapping of carriers during the device’s operation. This directly affects the performance and operation of the OLED devices, including brightness, electrical characteristics, and emission profile.

The inclusion of the 50 m butterfly, backstroke, and breaststroke events in the 2028 Olympic Games is likely to influence training methodologies and performance trajectories, considering that in competitive swimming, coaches already implement different training approaches for sprinter swimmers. This study examines whether elite sprint specialists, particularly those specializing in 50 m events, should prioritize high-intensity interval training (HIIT) over the traditionally dominant overdistance training models. The discussion aims to inform coaches and researchers about evolving approaches to sprint training and guide future research on intensity distribution in sprint swimming. There is a clear distinction in energy system demands between sprint events: the 50 m event has an aerobic contribution of approximately 20%, while in the 100 m event, the aerobic contribution can rise to around 40–50%. Despite the high anaerobic demands of the 50 m, many coaches continue to implement a Polarized Training Intensity Distribution (TID), characterized by a significant proportion of aerobic training. Based on recent developments in sprint swimming and some aspects of current literature support for the potential benefits of a greater emphasis on HIIT, assisted sprints, and overspeed training, along with earlier and more targeted specialization for sprinters, and an increased emphasis on dryland strength and conditioning. Nevertheless, further studies are needed to examine the efficacy of different TID approaches, particularly for elite athletes specializing exclusively in the 50 m distance.

Background: The aim of this study is to investigate the pathophysiology of cataract by analyzing signaling pathways in three sample types obtained from four different lens groups: age-related (ARC), diabetic (DC), post-vitrectomy cataract (PVC) and clear control lenses. Methods: Three sample types—the aqueous humor, the anterior capsule and the phaco cassette content—were collected during cataract surgery from 39 participants (ARC = 12, DC = 11, PVC = 7 and control = 9). The samples were prepared based on Sp3 protocol. The recognition and quantification of proteins were performed with liquid chromatography online with tandem mass spectrometry using the DIA-NN software. Perseus software (v1.6.15.0) was used for statistical analysis. Data are available via ProteomeXchange with identifiers PXD045547, PXD045554, PXD045557, and PXD069667. Results: In total, 1986 proteins were identified in the aqueous humor, 2804 in the anterior capsule, and 3337 in the phaco cassette samples. Proteins involved in actin and microtubule cytoskeleton organization, including ACTN4, were downregulated in all three cataract groups compared to controls. Proteins involved in glycolipid metabolic process, including GAL3ST1, GAL3ST4, and GLA, were upregulated in ARC compared to controls. Proteins involved in the non-canonical Wnt receptor signaling pathway, including FRZB, SFRP1, SFRP2, SFRP5, WNT5A, and WNT7A, were upregulated in ARC compared to DC, PVC, and controls. Conclusions: Comprehensive proteomic profiles were generated using DIA proteomics by comparing ARC, DC, and PVC versus controls. This is the first study to use phaco cassette contents to investigate cataract formation in comparison to controls. Our findings significantly enhance the current understanding of human cataract pathophysiology and provide novel insights into the mechanisms underlying cataract formation.