G. Papanikolaou General Hospital

To identify BKPyV, the VP1 protein sequence was analyzed and classified into genotypes in 246 RTRs before and after RTx from deceased donors during a one-year observation period. Quantitative assessment of BKPyV was conducted via qPCR. Prior to RTx, genotypes I and IV were identified in the urine (7.27 × 106; 1.20 × 105) and in serum (5.75 × 104; 1.12 × 104). After RTx, genotype I was predominant; identification of DNAuria-BKPyV (62.07%) and BKPyV-DNAemia (55.56%) peaked after three months, and the highest DNAuria-BKPyV titer was also observed after three months (6.48 × 109), whereas the BKPyV-DNAemia titer did not peak until after six months (2.21 × 107). The highest number of copies of genotype IV in the urine was observed after six months (9.54 × 109), while the highest titer in the serum was not observed until after 12 months (3.88 × 106). DNAuria-BKPyV precedes BKPyV-DNAemia, affects a larger group of patients, and has a greater and more easily detected viral load, which makes it not only an earlier marker, but the key predictive marker of greater clinical value than later detection of BKPyV-DNAemia alone. Early monitoring of DNAuria-BKPyV should be the basis of classical screening, and not merely an addition to it, and therapeutic interventions should be undertaken early to prevent nephropathy.

Pulmonary hypertension (PH) is a complex condition in which early diagnosis remains challenging, particularly in patients with exertional symptoms and normal or borderline resting haemodynamics. Although right heart catheterisation is the diagnostic gold standard, transthoracic echocardiography is the recommended first-line non-invasive test. However, resting echocardiography provides only a static assessment and may underestimate disease severity in early or latent pulmonary vascular disease due to preserved pulmonary vascular compliance and adaptive right ventricular responses. Because pulmonary haemodynamics are intrinsically flow-dependent, pathological abnormalities may only emerge during increased cardiac output. Stress echocardiography, performed using exercise or pharmacological stress, enables dynamic evaluation of pulmonary pressure responses, cardiac output augmentation, right ventricular contractile reserve, and ventricular interaction. Increasing evidence indicates that stress echocardiography can unmask abnormal pulmonary pressure-flow relationships, impaired pulmonary vascular reserve, and reduced right ventricular-pulmonary arterial coupling that are not apparent at rest, thereby improving functional and haemodynamic characterisation in selected patients. This Diagnostic Review outlines the physiological basis for stress echocardiographic assessment of pulmonary circulation, proposes practical recommendations for patient selection and testing protocols, and provides a framework for interpretation centered on pressure-flow relationships rather than absolute pulmonary pressure thresholds. Particular attention is given to clinical scenarios with high diagnostic yield, including unexplained exertional dyspnoea, systemic sclerosis, suspected heart failure with preserved ejection fraction, at-risk relatives of patients with pulmonary arterial hypertension, selected athletes, and paediatric populations. Stress echocardiography should not be considered a standalone diagnostic test for PH but, when performed in experienced centers and integrated within structured diagnostic pathways, it represents a valuable non-invasive adjunct to guide referral for invasive haemodynamic confirmation.

In the original publication [...].

Background and Objectives: Lumbar disk herniation with radiculopathy (LDHR) is a prevalent neuromusculoskeletal condition characterized by nociceptive and neuropathic pain components. Manual therapy (MT) is commonly used in its management, whereas Functional Magnetic Stimulation (FMS) represents an emerging modality with limited evidence in radiculopathy. The aim of this study was to examine the short-term effects of combining MT with FMS compared with MT alone on pain intensity, neuropathic pain features, neural mechanosensitivity, and functional disability in individuals with chronic LDHR. Materials and Methods: Forty adults with MRI-confirmed unilateral LDHR were randomly allocated to an MT + FMS group or an MT-only group. Both groups received ten treatment sessions over three weeks. Outcomes included lumbar and leg pain intensity (NPRS), functional disability (RMDQ), neuropathic pain symptoms (S-LANSS), and straight leg raise (SLR) range of motion. Measurements were obtained at baseline and at week 3. Group and time effects were examined using a two-way mixed ANOVA with significance set at p < 0.05. Results: Significant group × time interactions were observed for all outcomes (p < 0.01), indicating greater improvements in the MT + FMS group. Reductions in lumbar and leg pain, disability, and S-LANSS scores exceeded established MCID thresholds, while SLR gains surpassed published MDC values, reflecting both statistical and clinical relevance. Only the MT + FMS group improved below the neuropathic pain diagnostic cutoff (S-LANSS < 12). Conclusions: The findings of this trial suggest that incorporating FMS into a manual therapy program may provide additional short-term clinical benefits for individuals with chronic LDHR. Further research with larger samples, longer follow-up periods, and mechanistic assessments is needed to confirm these preliminary results and to better understand the underlying mechanisms.

Slow transit constipation (STC) is a chronic colonic motility disorder characterized by markedly delayed transit, leading to reduced bowel movements, abdominal discomfort, and significant quality-of-life impairment. It predominantly affects women and is associated with abnormalities in enteric neuronal signaling, smooth muscle contractility, interstitial cells of Cajal, gut peptides, bile acid homeostasis, and autonomic regulation. Secondary causes of constipation and structural lesions must be excluded before the diagnosis of STC, with colonic transit studies serving as the gold standard. Complementary investigations such as anorectal manometry and defecography help detect coexisting outlet obstruction, which can alter management. The treatment of STC should follow a stepwise approach, beginning with dietary and lifestyle modification, osmotic and stimulant laxatives, and prokinetics such as prucalopride. Secretagogues and bile acid modulators may offer additional benefit. Biofeedback therapy is primarily indicated for overlapping dyssynergic defecation. For refractory STC, interventional therapies, such as fecal microbiota transplantation, acupuncture, sacral nerve stimulation, and transanal irrigation, are found to have equivocal outcomes. Antegrade continence enema procedures can be an alternative for patients unsuitable for colectomy. Surgical options, including subtotal colectomy with ileosigmoid or cecorectal anastomosis, and total colectomy with ileorectal anastomosis, are reserved for carefully selected patients with medically intractable symptoms, following thorough physiological evaluation. Although advances in understanding STC pathophysiology are guiding novel therapeutic development, robust randomized controlled trials remain scarce. Optimal care requires multidisciplinary collaboration between gastroenterologists, colorectal surgeons, and pelvic floor specialists to ensure accurate diagnosis, tailored treatment, and improved long-term outcomes.

<ns3:p>Introduction: Investment in human capital is a strategic imperative in a highly competitive work environment, such as that of a hospital. Job satisfaction and retention in the profession largely depend on staff motivation.Purpose: This review study focuses on Herzberg's motivation-hygiene theory and its application in the nursing profession to improve job satisfaction and performance.Materials and methods: A literature review was conducted using articles and research studies from the last decade, retrieved from the electronic databases PubMed and Google Scholar.Results. Nursing is one of the most demanding and psychologically draining professional fields. Hospital management is required to find ways to enhance the working culture of nurses. In this context, Herzberg's motivation-hygiene theory can be applied to the nursing profession to improve job satisfaction and performance.Conclusions: Nurse motivation is linked to moral satisfaction, recognition, and career development. Herzberg's theory can serve as a foundation for designing policies that promote a respectful environment with growth opportunities.</ns3:p>

To develop expert consensus recommendations for patient selection and procedural techniques in cryoneurolysis for chronic pain management using a Delphi process. A panel of 22 international interventionists participated in a two-round Delphi process. Participants rated 42 statements on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Consensus was predefined as ≥ 75% of ratings ≥ 7. Descriptive statistics (n, mean ± SD, % ≥ 7) were calculated. High agreement supported cryoneurolysis for localized chronic pain refractory to conservative therapies (mean 8.55 ± 0.60; 100% ≥ 7) and cases with identifiable peripheral nerve targets (8.45 ± 0.74; 100% ≥ 7). Imaging guidance was deemed essential for nerve identification and probe placement (8.91 ± 0.29; 100% ≥ 7). The panel endorsed individualized freeze-thaw cycles to achieve Sunderland II injury (8.27 ± 0.83; 91% ≥ 7) and emphasized thorough patient education (9.0 ± 0.0; 100% ≥ 7). Experts recommended repeat cryoneurolysis within weeks if initial response was incomplete (8.64 ± 0.65; 100% ≥ 7) and alternative therapies after two unsuccessful sessions (8.36 ± 0.73; 95% ≥ 7). No consensus was reached on restricting treatment to a single anatomical region (5.82 ± 2.91; 50% ≥ 7) or routine prophylactic antibiotics (6.27 ± 2.57; 54% ≥ 7). This Delphi study establishes expert-derived consensus standards for cryoneurolysis, highlighting careful patient selection, mandatory imaging guidance, and flexible freeze protocols while identifying areas requiring further research.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease characterized by exertional dyspnea, desaturation, and exercise intolerance. Desaturation may contribute to cerebral hypoxia during exercise, and in turn, to exercise intolerance. Although pulmonary rehabilitation (PR) has been shown to improve functional capacity and symptom management, it remains unclear whether these benefits are partially mediated by improved brain oxygenation. To evaluate whether a 12-month PR program enhances cerebral oxygenation during exercise in patients with IPF. Secondary outcomes included exercise capacity, cognitive function, depression/anxiety, and physical activity levels. Sixteen patients with IPF (68.7 ± 6.4 yr), on antifibrotic therapy, completed a 12-mo supervised PR intervention involving aerobic, resistance, flexibility, and breathing exercises. Pre- and post-intervention assessments included spirometry, cardiopulmonary exercise testing, cerebral oxygenation via near-infrared-spectroscopy, Mini-Mental State Examination, Hospital Anxiety/Depression Scale, and International Physical Activity Questionnaire. After the PR intervention, cerebral oxygenated hemoglobin (O 2 Hb mean-response ) during exercise was higher ( P = 0.04) compared with pre-PR exercise testing. Isowork O 2 Hb responses (at 50% and 75% of pre-PR peak workload) were significantly elevated ( P = 0.006). The PR intervention resulted in improved VO 2 peak ( P = 0.01), cardiopulmonary exercise testing duration, and peak workload ( P = 0.02). Hospital Anxiety/Depression Scale anxiety/depression scores decreased ( P = 0.01; P < 0.001); the Mini-Mental State Examination was not significantly changed ( P = 0.054). Physical activity levels increased from "low" to "moderate" ( P < 0.001). Training-induced cerebral oxygenation improvements were significantly correlated with improvements in exercise capacity (VO 2 peak % predicted , r = 0.54, P = 0.03; Workload peakr = 0.54, P = 0.03) and mMRC. ( r = 0.63, P = 0.01). A 12-month PR program enhanced cerebral oxygenation during exercise, improved exercise capacity, physical activity levels, and psychological well-being of IPF patients. Importantly, our findings suggest a potential association between improved cerebral oxygenation and enhanced exercise capacity in IPF.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Respiratory infections demonstrate characteristic seasonal variations influenced by environmental factors; however, the specific meteorological determinants for individual pathogens remain insufficiently defined. This retrospective study investigated associations between weather parameters and the prevalence of upper respiratory pathogens in northern Greece from December 2023 to November 2024. Nasopharyngeal specimens collected from patients at AHEPA University Hospital of Thessaloniki with suspected infections were analyzed using multiplex polymerase chain reaction (PCR). Meteorological data were incorporated through a novel timeweighted approach that aligned weather data with pathogen-specific incubation periods. Among 1,754 samples analyzed, winter exhibited the highest positivity rate. Distinct seasonal and meteorological relationships were identified across pathogens. Influenza A was associated with colder and more humid conditions, Adenovirus predominated in warmer periods, and other viruses displayed year-round or seasonally limited circulation. Distinct correlation profiles were also observed, including variations in temperature-humidity relationships among specific pathogens. These findings reveal pathogen-specific meteorological signatures extending beyond conventional seasonality and highlight the utility of time-weighted environmental modeling for improving predictive surveillance and public health preparedness.