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Prof. Dr. George P. Chrousos
National and Kapodistrian University of Athens, Athens, Greece

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0 Endocrinology
0 Epigenetics
0 Genetics
0 Human Physiology
0 Pediatric Endocrinology

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Journal article
Published: 03 August 2021 in Children
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Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.

ACS Style

Emmanuella Magriplis; George Michas; Evgenia Petridi; George Chrousos; Eleftheria Roma; Vassiliki Benetou; Nikos Cholopoulos; Renata Micha; Demosthenes Panagiotakos; Antonis Zampelas. Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents. Children 2021, 8, 676 .

AMA Style

Emmanuella Magriplis, George Michas, Evgenia Petridi, George Chrousos, Eleftheria Roma, Vassiliki Benetou, Nikos Cholopoulos, Renata Micha, Demosthenes Panagiotakos, Antonis Zampelas. Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents. Children. 2021; 8 (8):676.

Chicago/Turabian Style

Emmanuella Magriplis; George Michas; Evgenia Petridi; George Chrousos; Eleftheria Roma; Vassiliki Benetou; Nikos Cholopoulos; Renata Micha; Demosthenes Panagiotakos; Antonis Zampelas. 2021. "Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents." Children 8, no. 8: 676.

Journal article
Published: 01 August 2021 in Cancers
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Personalized medicine incorporates genetic information into medical practice so as to optimize the management of chronic diseases. In rare diseases, such as heart cancer (incidence 0.0017–0.33%), this may be elusive. Ninety-five percent of the cases are due to secondary involvementwith the neoplasm originating in the lungs, breasts, kidney, blood, or skin. The clinical manifestations of heart tumors (benign or malignant) include heart failure, hypertension, and cardiac arrhythmias of varying severity, frequently resulting in blood vessel emboli, including strokes. This study aims to explain the pathophysiology and contribute to a P4 medicine model for use by cardiologists, pathologists, and oncologists. We created six gene/protein heart-related and tumor-related targets high-confidence interactomes, which unfold the main pathways that may lead to cardiac diseases (heart failure, hypertension, coronary artery disease, arrhythmias), i.e., the sympathetic nervous system, the renin-angiotensin-aldosterone axis and the endothelin pathway, and excludes others, such as the K oxidase or cytochrome P450 pathways. We concluded that heart cancer patients could be affected by beta-adrenergic blockers, ACE inhibitors, QT-prolonging antiarrhythmic drugs, antibiotics, and antipsychotics. Interactomes may elucidate unknown pathways, adding to patient/survivor wellness during/after chemo- and/or radio-therapy.

ACS Style

Styliani Geronikolou; Athanasia Pavlopoulou; George Chrousos; Dennis Cokkinos. Interactions Networks for Primary Heart Sarcomas. Cancers 2021, 13, 3882 .

AMA Style

Styliani Geronikolou, Athanasia Pavlopoulou, George Chrousos, Dennis Cokkinos. Interactions Networks for Primary Heart Sarcomas. Cancers. 2021; 13 (15):3882.

Chicago/Turabian Style

Styliani Geronikolou; Athanasia Pavlopoulou; George Chrousos; Dennis Cokkinos. 2021. "Interactions Networks for Primary Heart Sarcomas." Cancers 13, no. 15: 3882.

Perspective
Published: 31 July 2021 in Children
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Lifestyle intervention programs, including mindfulness and stress management/emotional control training techniques have been infrequently studied in children. The aim of this systematic review was to assess whether implementing stress management/emotional control training strategies in the context of a body weight loss program in children and adolescents is associated with improved body weight outcome in this age group. A systematic literature search was conducted to identify relevant studies published before 31 December 2020 in the following databases: Medline (PubMed), Scopus, and Cochrane Central Registry of Controlled Trials. Only randomized clinical trials (RCTs) on mindfulness or stress management in children and adolescents with obesity were included in this systematic review. Six RCTs fulfilled the study inclusion criteria and included intervention (112 subjects) and control (137 subjects) groups. The interventions used were Mindfulness-Based Stress Reduction therapy for 8 weeks (three studies), a mindfulness-based group program for adolescents (one study), and Mindful Eating Intervention for 6 weeks (one study) and 10 weeks (one study). The intervention group demonstrated reduced adiposity markers as compared to controls in four of the six included studies. The presented studies support the hypothesis that a structured, mindfulness-based intervention program may lead to a decrease in the biomarkers of obesity.

ACS Style

George Paltoglou; George Chrousos; Flora Bacopoulou. Stress Management as an Effective Complementary Therapeutic Strategy for Weight Loss in Children and Adolescents with Obesity: A Systematic Review of Randomized Controlled Trials. Children 2021, 8, 670 .

AMA Style

George Paltoglou, George Chrousos, Flora Bacopoulou. Stress Management as an Effective Complementary Therapeutic Strategy for Weight Loss in Children and Adolescents with Obesity: A Systematic Review of Randomized Controlled Trials. Children. 2021; 8 (8):670.

Chicago/Turabian Style

George Paltoglou; George Chrousos; Flora Bacopoulou. 2021. "Stress Management as an Effective Complementary Therapeutic Strategy for Weight Loss in Children and Adolescents with Obesity: A Systematic Review of Randomized Controlled Trials." Children 8, no. 8: 670.

Journal article
Published: 06 July 2021 in Biosensors
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The availability of antigen tests for SARS-CoV-2 represents a major step for the mass surveillance of the incidence of infection, especially regarding COVID-19 asymptomatic and/or early-stage patients. Recently, we reported the development of a Bioelectric Recognition Assay-based biosensor able to detect the SARS-CoV-2 S1 spike protein expressed on the surface of the virus in just three minutes, with high sensitivity and selectivity. The working principle was established by measuring the change of the electric potential of membrane-engineered mammalian cells bearing the human chimeric spike S1 antibody after attachment of the respective viral protein. In the present study, we applied the novel biosensor to patient-derived nasopharyngeal samples in a clinical set-up, with absolutely no sample pretreatment. More importantly, membrane-engineered cells were pre-immobilized in a proprietary biomatrix, thus enabling their long-term preservation prior to use as well as significantly increasing their ease-of-handle as test consumables. The plug-and-apply novel biosensor was able to detect the virus in positive samples with a 92.8% success rate compared to RT-PCR. No false negative results were recorded. These findings demonstrate the potential applicability of the biosensor for the early, routine mass screening of SARS-CoV-2 on a scale not yet realized.

ACS Style

Sophie Mavrikou; Vasileios Tsekouras; Kyriaki Hatziagapiou; Foteini Paradeisi; Petros Bakakos; Athanasios Michos; Antonia Koutsoukou; Elissavet Konstantellou; George Lambrou; Eleni Koniari; Elizabeth-Barbara Tatsi; Joseph Papaparaskevas; Dimitrios Iliopoulos; George Chrousos; Spyridon Kintzios. Clinical Application of the Novel Cell-Based Biosensor for the Ultra-Rapid Detection of the SARS-CoV-2 S1 Spike Protein Antigen: A Practical Approach. Biosensors 2021, 11, 224 .

AMA Style

Sophie Mavrikou, Vasileios Tsekouras, Kyriaki Hatziagapiou, Foteini Paradeisi, Petros Bakakos, Athanasios Michos, Antonia Koutsoukou, Elissavet Konstantellou, George Lambrou, Eleni Koniari, Elizabeth-Barbara Tatsi, Joseph Papaparaskevas, Dimitrios Iliopoulos, George Chrousos, Spyridon Kintzios. Clinical Application of the Novel Cell-Based Biosensor for the Ultra-Rapid Detection of the SARS-CoV-2 S1 Spike Protein Antigen: A Practical Approach. Biosensors. 2021; 11 (7):224.

Chicago/Turabian Style

Sophie Mavrikou; Vasileios Tsekouras; Kyriaki Hatziagapiou; Foteini Paradeisi; Petros Bakakos; Athanasios Michos; Antonia Koutsoukou; Elissavet Konstantellou; George Lambrou; Eleni Koniari; Elizabeth-Barbara Tatsi; Joseph Papaparaskevas; Dimitrios Iliopoulos; George Chrousos; Spyridon Kintzios. 2021. "Clinical Application of the Novel Cell-Based Biosensor for the Ultra-Rapid Detection of the SARS-CoV-2 S1 Spike Protein Antigen: A Practical Approach." Biosensors 11, no. 7: 224.

Journal article
Published: 01 July 2021 in Mechanisms of Ageing and Development
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Stress accelerates aging by affecting relevant cellular pathways including, among others, leucocyte telomere length (LTL) and proteasome levels. Their impaired function underlies several age-related and non-communicable conditions, such as type 2 diabetes mellitus. The aim of the present study was to investigate, for the first time, the dynamics of stress-related aging factors in the frame of a novel stress-management technique, the Pythagorean Self Awareness Intervention (PSAI), in healthy volunteers and adults with type 2 diabetes. To this end a cohort of 311 healthy volunteers was initially studied and LTL and proteasome levels were analysed in a subgroup of healthy volunteers and adults with type 2 diabetes who were enrolled in the PSAI, with regards to specific physio- and psychometric characteristics of the participants (baseline and post-intervention). We have found a significant improvement of aging biomarkers and of psycho-/bio-factors in all participants. More specifically, post-intervention, both healthy adults and patients with type 2 diabetes demonstrated improved LTL and proteasome levels. Significant improvements were also observed in psychometric, anthropometric and key metabolic features as well as in hair cortisol. In conclusion our results highlighted potential key targets of such interventions and prognostic tools for the assessment of aging pace in clinical practice.

ACS Style

Sophia Athanasopoulou; Dimitrios Simos; Maria Charalampopoulou; Nikolaos Tentolouris; Alexandros Kokkinos; Flora Bacopoulou; Elena Aggelopoulou; Eleni Zigkiri; George P. Chrousos; Christina Darviri; Efstathios S. Gonos. Significant Improvement of Stress and Aging Biomarkers Using a Novel Stress Management Program with the Cognitive Restructuring Method "Pythagorean Self-Awareness Intervention" in Patients with Type 2 Diabetes Mellitus and Healthy Adults. Mechanisms of Ageing and Development 2021, 198, 111538 .

AMA Style

Sophia Athanasopoulou, Dimitrios Simos, Maria Charalampopoulou, Nikolaos Tentolouris, Alexandros Kokkinos, Flora Bacopoulou, Elena Aggelopoulou, Eleni Zigkiri, George P. Chrousos, Christina Darviri, Efstathios S. Gonos. Significant Improvement of Stress and Aging Biomarkers Using a Novel Stress Management Program with the Cognitive Restructuring Method "Pythagorean Self-Awareness Intervention" in Patients with Type 2 Diabetes Mellitus and Healthy Adults. Mechanisms of Ageing and Development. 2021; 198 ():111538.

Chicago/Turabian Style

Sophia Athanasopoulou; Dimitrios Simos; Maria Charalampopoulou; Nikolaos Tentolouris; Alexandros Kokkinos; Flora Bacopoulou; Elena Aggelopoulou; Eleni Zigkiri; George P. Chrousos; Christina Darviri; Efstathios S. Gonos. 2021. "Significant Improvement of Stress and Aging Biomarkers Using a Novel Stress Management Program with the Cognitive Restructuring Method "Pythagorean Self-Awareness Intervention" in Patients with Type 2 Diabetes Mellitus and Healthy Adults." Mechanisms of Ageing and Development 198, no. : 111538.

Journal article
Published: 30 June 2021 in Sustainability
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This study evaluated the short-term responses of physiological and psychological indices and examined the human senses that are mostly engaged during a green space and urban exposure in residents of Athens, Greece. The forest had beneficial effects for human physiology, anxiety and mood states and was also associated with all five senses and positive reactions, while the opposite was observed in the urban center. The difference of pre- and post-green space exposure salivary cortisol was correlated with the participants’ environmental profile and body mass index. Green spaces can alleviate stress and improve overall mood, while helping individuals experience their surroundings with all five senses.

ACS Style

Argyro Kanelli; Panayiotis Dimitrakopoulos; Nikolaos Fyllas; George Chrousos; Olga-Ioanna Kalantzi. Engaging the Senses: The Association of Urban Green Space with General Health and Well-Being in Urban Residents. Sustainability 2021, 13, 7322 .

AMA Style

Argyro Kanelli, Panayiotis Dimitrakopoulos, Nikolaos Fyllas, George Chrousos, Olga-Ioanna Kalantzi. Engaging the Senses: The Association of Urban Green Space with General Health and Well-Being in Urban Residents. Sustainability. 2021; 13 (13):7322.

Chicago/Turabian Style

Argyro Kanelli; Panayiotis Dimitrakopoulos; Nikolaos Fyllas; George Chrousos; Olga-Ioanna Kalantzi. 2021. "Engaging the Senses: The Association of Urban Green Space with General Health and Well-Being in Urban Residents." Sustainability 13, no. 13: 7322.

Opinion article
Published: 29 June 2021 in Frontiers in Immunology
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Sjogren syndrome (SS) is historically the prototype autoimmune disease of the moisture-producing salivary and lacrimal glands, leading respectively to dry mouth and eyes, and represents an exemplar autoimmune disease for the molecular immunologist (1). SS is also a systemic disease with manifestations from several organs, notably including the lungs, the kidneys, the liver, and the vascular system [for a description of the full clinical spectrum of SS, see (2)]. Therefore, treatment for SS should include addressing both local symptoms (i.e., xerosis), but also the underlying immunological aetiopathogenic mechanisms (3). As a model autoimmune disease, SS has been the basis of a four decades-spanning scientific journey (4); during these forty years, many exciting findings have appeared conveying broader implications for autoimmune diseases and causing shifts in SS clinical management. Indicatively, a) the preliminary criteria for SS (5) have been thoroughly re-assessed, revised, and updated (6–8); b) the risk factors for lymphoma development, in particular Non-Hodgkin lymphoma in SS patients, has now been well-established (9) [whose development can be predicted with very high accuracy using appropriate predictive risk scores (10)]; hence, nowadays we know that lymphoma causes 20% of deaths in patients with SS (11); and, c) SS is an area of intensive recent clinical trials in the quest of effective treatment for a disease affecting 2 to 4 million people only in US (12). Of note, there is a recent, resurgent interest in SS in light of efforts to use immunomodulatory drugs for its control, whose efficacy though has not been proven in this condition as yet (13); however, hopes for improving symptoms of dry mouth and eyes with such agents remain high. Intriguingly, a recent publication could provide unexpected clues to the SS arena even if it stems from the field of radiotherapy (14). According to the study’s findings, new bilateral salivary glands, called tubarial glands, −which are apparent even at the macroscopic level−, were recently described in patients with cancer. This observation was made possible using prostate-specific membrane antigen ligands (PSMA PET/CT) in a recently employed nuclear medicine approach that bears high diagnostic accuracy for salivary glands (15); actually, the finding was confirmed histologically in cadavers (14). Thus, tubarial glands are described as being located between the throat and the nasal cavity, notably torus tubarius, from which they derive their name. In addition, radiotherapy including the pharyngeal area of these glands led to xerostomia and dysphagia, suggesting, first, a major functional role for these recently described organs, and, second, a potential for averting these symptoms by avoiding radiation of this region (14). While fully acknowledging the differences in focus of the consideration below, could these recently identified salivary glands have significant implications for SS? We contend that significance in light of their location and possible functionality and, hence, suggest that it would be worth investigating whether these glands are compromised in SS patients, not least in the subcategory of those with diagnosed SS and a dry rhinopharynx. Were this the case, it could provide a major anatomical clue to a SS subcategory and could be the impetus for future studies in the field. To this end, a multi-center PSMA PET/CT study of SS patients with or without a dry rhinopharynx could shed light into tubarial glands’ role in SS. If it were possible to anatomically access these glands and to conduct biopsies, one could confirm whether they are involved in SS or not. In the former case, SS classification and diagnostic criteria might be reformed (16). Nonetheless, several critiques (expressed as letters to the Editor) have been expressed about this discovery. The concerns expressed refer to a) the small patient population and the confirmatory data only obtained in two cadavers; b) the male predominance in the study’s participants with prostate or urethral gland cancer and only a single woman, thus indicating a lack of diversity of the population studied (17); c) whether these glands are true salivary glands in the sense that they contribute to saliva’s production, granted that they lack amylase (18); and, d) whether these glands are truly novel and not a redescription of findings reported by 19th anatomists (19). Moreover, concerns have been raised on the imaging techniques that were applied for the identification of tumor growths in a specific patient population rather than in the general population. Hence, in light of the lack of consensus and current uncertainties on the tubarial glands, the opinion we here-in propose would require first the above work to be widened to include a) larger populations, b) other confirmatory imagining methods, c) further studies in female patients, and d) more extensive histological and immunohistochemical analyses, including comparison with findings described in major and minor labial salivary glands of patients with SS. We also contend that regardless of whether the above investigation is a mere academic exercise or one potentially ending in changing SS-related clinical practice, the implications may raise a broader scientific question, i.e., should these observations be treated as a discovery or re-discovery? Similarly, other recent discoveries have been made regarding anatomical descriptions and sites that were presented as novel, namely a) the meningeal lymphatic vessels (20); b) the interstitium as a fluid-filling space between cells (21); c) the mesentery as a complete organ instead of fragmented parts (22); d) the discovery of arterial and venous capillaries in long bones (23); e) the presence of atavistic limb muscles in human embryos (24); and, f) the increase in the incidence of the sesamoid bone fabella over the last 150 years (25). Criticisms on the...

ACS Style

Alexios-Fotios A. Mentis; George P. Chrousos. Tubarial Salivary Glands in Sjogren Syndrome: Are They Just a Potential Missing Link With No Broader Implications? Frontiers in Immunology 2021, 12, 684490 .

AMA Style

Alexios-Fotios A. Mentis, George P. Chrousos. Tubarial Salivary Glands in Sjogren Syndrome: Are They Just a Potential Missing Link With No Broader Implications? Frontiers in Immunology. 2021; 12 ():684490.

Chicago/Turabian Style

Alexios-Fotios A. Mentis; George P. Chrousos. 2021. "Tubarial Salivary Glands in Sjogren Syndrome: Are They Just a Potential Missing Link With No Broader Implications?" Frontiers in Immunology 12, no. : 684490.

Review
Published: 07 June 2021 in European Journal of Clinical Investigation
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Background Iatrogenic adrenal insufficiency (AI) secondary to long-term treatment with exogenous glucocorticoids (GC) is common in patients with systematic rheumatic diseases, including rheumatoid arthritis (RA). Moreover, a proportion of these patients is always in need of even small doses of glucocorticoids to maintain clinical remission, despite concomitant treatment with conventional and biologic disease-modifying drugs. Methods We conducted a literature review up to December 2020 on (a) the incidence of AI in both long-term GC-treated and GC-treatment naïve RA patients; (b) the potential effects of increased levels of circulating proinflammatory cytokines, as well as of chronic stress, in adrenocortical function in RA; (c) the circadian cortisol rhythm in RA; and (d) established and evolving methods of assessment of adrenocortical function. Results Up to 48% of RA patients develop glucocorticoid-induced AI; however, predictors are not established, while adrenocortical dysfunction may also occur in GC-treatment naïve RA patients. Experimental and clinical data have suggested that inadequate production of endogenous cortisol relative to enhanced clinical needs associated with the systemic inflammatory response, coined as the ‘disproportion principle’, may operate in RA. Although the underlying mechanisms are unknown, both proinflammatory cytokines and chronic stress may contribute the most in the adrenals hyporesponsiveness and the target tissue glucocorticoid resistance that have been described, but not systematically studied. A precise longitudinal assessment of endogenous cortisol production may be needed for optimal RA management. Conclusion Apart from iatrogenic AI, an intrinsically compromised adrenal reserve in RA may have a pathogenetic role and interfere with effective management, thus deserving further research.

ACS Style

Maria G. Filippa; Maria G. Tektonidou; Aimilia Mantzou; Gregory A. Kaltsas; George P. Chrousos; Petros P. Sfikakis; Maria P. Yavropoulou. Adrenocortical Dysfunction in Rheumatoid Arthritis: Α Narrative Review and Future Directions. European Journal of Clinical Investigation 2021, e13635 .

AMA Style

Maria G. Filippa, Maria G. Tektonidou, Aimilia Mantzou, Gregory A. Kaltsas, George P. Chrousos, Petros P. Sfikakis, Maria P. Yavropoulou. Adrenocortical Dysfunction in Rheumatoid Arthritis: Α Narrative Review and Future Directions. European Journal of Clinical Investigation. 2021; ():e13635.

Chicago/Turabian Style

Maria G. Filippa; Maria G. Tektonidou; Aimilia Mantzou; Gregory A. Kaltsas; George P. Chrousos; Petros P. Sfikakis; Maria P. Yavropoulou. 2021. "Adrenocortical Dysfunction in Rheumatoid Arthritis: Α Narrative Review and Future Directions." European Journal of Clinical Investigation , no. : e13635.

Journal article
Published: 05 June 2021 in Children
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High mobility group box 1 protein (HMGB1) has been suggested to be involved in the immune dysfunction and inflammation reported in autism spectrum disorder (ASD). We aimed to assess HMGB1 serum concentrations (SCs) in high-functioning ASD children compared to typically developing (TD) controls and to explore their associations with the autism spectrum quotient (AQ), the empathy quotient (EQ), and the systemizing quotient (SQ). The study involved 42 ASD children and 38 TD children, all-male, aged between 6.1 and 13.3 years old. HMGB1 SCs were measured by enzyme-linked immunosorbent assay (ELISA). Groups were comparable regarding age, general IQ, birth weight, and maternal age at birth. ASD children showed significantly higher HMGB1 SCs compared to TD children (1.25 ± 0.84 ng/mL versus 1.13 ± 0.79 ng/mL, respectively, p = 0.039). The Spearman’s rho revealed that HMGB1 SCs were positively correlated with the AQ attention to detail subscale (rs = 0.46, p = 0.045) and with the SQ total score (rs = 0.42, p = 0.04) in the ASD group. These results show that HMGB1 serum concentrations are altered in ASD children, and suggest that inflammatory processes mediated by HMGB1 may be associated with specific cognitive features observed in ASD.

ACS Style

Gerasimos Makris; Giorgos Chouliaras; Filia Apostolakou; Charalabos Papageorgiou; George Chrousos; Ioannis Papassotiriou; Panagiota Pervanidou. Increased Serum Concentrations of High Mobility Group Box 1 (HMGB1) Protein in Children with Autism Spectrum Disorder. Children 2021, 8, 478 .

AMA Style

Gerasimos Makris, Giorgos Chouliaras, Filia Apostolakou, Charalabos Papageorgiou, George Chrousos, Ioannis Papassotiriou, Panagiota Pervanidou. Increased Serum Concentrations of High Mobility Group Box 1 (HMGB1) Protein in Children with Autism Spectrum Disorder. Children. 2021; 8 (6):478.

Chicago/Turabian Style

Gerasimos Makris; Giorgos Chouliaras; Filia Apostolakou; Charalabos Papageorgiou; George Chrousos; Ioannis Papassotiriou; Panagiota Pervanidou. 2021. "Increased Serum Concentrations of High Mobility Group Box 1 (HMGB1) Protein in Children with Autism Spectrum Disorder." Children 8, no. 6: 478.

Original article
Published: 14 May 2021 in European Journal of Pediatrics
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The aim of this study was to develop and examine the predictive accuracy of an index that estimates obesity risk in childhood based on perinatal factors and maternal sociodemographic characteristics. Analysis was conducted by using cross-sectional and retrospective data collected from a European cohort of 2775 schoolchildren and their families participating in the Feel4Diabetes-study. The cohort was randomly divided by using two-thirds of the sample for the development of the index and the remaining one third for assessing its predictive accuracy. Logistic regression analyses determined a prediction model for childhood obesity. The area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated. Cut-off analysis was applied to identify the optimal value of the index score that predicts obesity with the highest possible sensitivity and specificity. Eight factors were found to be significantly associated with obesity and were included as components in the European “Childhood Obesity Risk Evaluation” (CORE) index: region of residence, maternal education, maternal pre-pregnancy weight status, gestational weight gain, maternal smoking during pregnancy, birth weight for gestational age, infant growth velocity, and exclusive breastfeeding during the first 6 months. Risk score ranged from 0 to 22 corresponding to a risk from 0.9 to 54.6%. The AUC-ROC was 0.725 with optimal cut-off ≥9 (sensitivity = 74.1%, specificity = 61.0%, PPV = 11.3%, NPV = 97.2%). Conclusion: The European CORE index can be used as a screening tool for the identification of infants at high-risk for becoming obese at 6–9 years. This tool could assist healthcare professionals in initiating preventive measures from the early life. Trial registration: The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/; number, CT02393872; date, March 20, 2015.

ACS Style

Christina Mavrogianni; George Moschonis; Eva Karaglani; Greet Cardon; Violeta Iotova; Pilar De Miguel-Etayo; Esther M. González-Gil; Κaloyan Tsochev; Tsvetalina Tankova; Imre Rurik; Patrick Timpel; Emese Antal; Stavros Liatis; Konstantinos Makrilakis; George P. Chrousos; Yannis Manios. European Childhood Obesity Risk Evaluation (CORE) index based on perinatal factors and maternal sociodemographic characteristics: the Feel4Diabetes-study. European Journal of Pediatrics 2021, 1 -13.

AMA Style

Christina Mavrogianni, George Moschonis, Eva Karaglani, Greet Cardon, Violeta Iotova, Pilar De Miguel-Etayo, Esther M. González-Gil, Κaloyan Tsochev, Tsvetalina Tankova, Imre Rurik, Patrick Timpel, Emese Antal, Stavros Liatis, Konstantinos Makrilakis, George P. Chrousos, Yannis Manios. European Childhood Obesity Risk Evaluation (CORE) index based on perinatal factors and maternal sociodemographic characteristics: the Feel4Diabetes-study. European Journal of Pediatrics. 2021; ():1-13.

Chicago/Turabian Style

Christina Mavrogianni; George Moschonis; Eva Karaglani; Greet Cardon; Violeta Iotova; Pilar De Miguel-Etayo; Esther M. González-Gil; Κaloyan Tsochev; Tsvetalina Tankova; Imre Rurik; Patrick Timpel; Emese Antal; Stavros Liatis; Konstantinos Makrilakis; George P. Chrousos; Yannis Manios. 2021. "European Childhood Obesity Risk Evaluation (CORE) index based on perinatal factors and maternal sociodemographic characteristics: the Feel4Diabetes-study." European Journal of Pediatrics , no. : 1-13.

Review
Published: 05 May 2021 in European Journal of Clinical Investigation
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The polycystic ovary syndrome (PCOS) has genetic, epigenetic, metabolic and reproductive aspects, while Its complex pathophysiology has not been conclusively deciphered. The goal of this research is to screen the gene/gene products associated with PCOS and to predict any possible interactions with the highest possible fidelity. This study thus may contribute to the resolution of a scientific conflict between US and EU definition of the syndrome and/or provide a new P4 medicine approach. STRING v10.5 database and a confidence level of 0.7 were used to create a highly interconnected network of 48 nodes, where insulin (INS) appears to be the major hub. INS upstream and downstream defects were analyzed and revealed that only the kisspeptin and glucagon coding genes were upstream to INS. A metabolic dominance was, thus, inferred, and discussed herein with its implications in puberty, obesity, infertility and cardiovascular function.

ACS Style

Styliani A. Geronikolou; Athanassia Pavlopoulou; Dennis V. Cokkinos; Flora Bacopoulou; George P. Chrousos. Polycystic οvary syndrome revisited: An interactions network approach. European Journal of Clinical Investigation 2021, 51, e13578 .

AMA Style

Styliani A. Geronikolou, Athanassia Pavlopoulou, Dennis V. Cokkinos, Flora Bacopoulou, George P. Chrousos. Polycystic οvary syndrome revisited: An interactions network approach. European Journal of Clinical Investigation. 2021; 51 (9):e13578.

Chicago/Turabian Style

Styliani A. Geronikolou; Athanassia Pavlopoulou; Dennis V. Cokkinos; Flora Bacopoulou; George P. Chrousos. 2021. "Polycystic οvary syndrome revisited: An interactions network approach." European Journal of Clinical Investigation 51, no. 9: e13578.

Review article
Published: 01 April 2021 in Hypertension
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The General Data Protection Regulation (GDPR) became binding law in the European Union Member States in 2018, as a step toward harmonizing personal data protection legislation in the European Union. The Regulation governs almost all types of personal data processing, hence, also, those pertaining to biomedical research. The purpose of this article is to highlight the main practical issues related to data and biological sample sharing that biomedical researchers face regularly, and to specify how these are addressed in the context of GDPR, after consulting with ethics/legal experts. We identify areas in which clarifications of the GDPR are needed, particularly those related to consent requirements by study participants. Amendments should target the following: (1) restricting exceptions based on national laws and increasing harmonization, (2) confirming the concept of broad consent, and (3) defining a roadmap for secondary use of data. These changes will be achieved by acknowledged learned societies in the field taking the lead in preparing a document giving guidance for the optimal interpretation of the GDPR, which will be finalized following a period of commenting by a broad multistakeholder audience. In parallel, promoting engagement and education of the public in the relevant issues (such as different consent types or residual risk for re-identification), on both local/national and international levels, is considered critical for advancement. We hope that this article will open this broad discussion involving all major stakeholders, toward optimizing the GDPR and allowing a harmonized transnational research approach.

ACS Style

Antonia Vlahou; Dara Hallinan; Rolf Apweiler; Angel Argiles; Joachim Beige; Ariela Benigni; Rainer Bischoff; Peter C. Black; Franziska Boehm; Jocelyn Céraline; George P. Chrousos; Christian Delles; Pieter Evenepoel; Ivo Fridolin; Griet Glorieux; Alain J. van Gool; Isabel Heidegger; John P.A. Ioannidis; Joachim Jankowski; Vera Jankowski; Carmen Jeronimo; Ashish M. Kamat; Rosalinde Masereeuw; Gert Mayer; Harald Mischak; Alberto Ortiz; Giuseppe Remuzzi; Peter Rossing; Joost P. Schanstra; Bernd J. Schmitz-Dräger; Goce Spasovski; Jan A. Staessen; Dimitrios Stamatialis; Peter Stenvinkel; Christoph Wanner; Stephen B. Williams; Faiez Zannad; Carmine Zoccali; Raymond Vanholder. Data Sharing Under the General Data Protection Regulation. Hypertension 2021, 77, 1029 -1035.

AMA Style

Antonia Vlahou, Dara Hallinan, Rolf Apweiler, Angel Argiles, Joachim Beige, Ariela Benigni, Rainer Bischoff, Peter C. Black, Franziska Boehm, Jocelyn Céraline, George P. Chrousos, Christian Delles, Pieter Evenepoel, Ivo Fridolin, Griet Glorieux, Alain J. van Gool, Isabel Heidegger, John P.A. Ioannidis, Joachim Jankowski, Vera Jankowski, Carmen Jeronimo, Ashish M. Kamat, Rosalinde Masereeuw, Gert Mayer, Harald Mischak, Alberto Ortiz, Giuseppe Remuzzi, Peter Rossing, Joost P. Schanstra, Bernd J. Schmitz-Dräger, Goce Spasovski, Jan A. Staessen, Dimitrios Stamatialis, Peter Stenvinkel, Christoph Wanner, Stephen B. Williams, Faiez Zannad, Carmine Zoccali, Raymond Vanholder. Data Sharing Under the General Data Protection Regulation. Hypertension. 2021; 77 (4):1029-1035.

Chicago/Turabian Style

Antonia Vlahou; Dara Hallinan; Rolf Apweiler; Angel Argiles; Joachim Beige; Ariela Benigni; Rainer Bischoff; Peter C. Black; Franziska Boehm; Jocelyn Céraline; George P. Chrousos; Christian Delles; Pieter Evenepoel; Ivo Fridolin; Griet Glorieux; Alain J. van Gool; Isabel Heidegger; John P.A. Ioannidis; Joachim Jankowski; Vera Jankowski; Carmen Jeronimo; Ashish M. Kamat; Rosalinde Masereeuw; Gert Mayer; Harald Mischak; Alberto Ortiz; Giuseppe Remuzzi; Peter Rossing; Joost P. Schanstra; Bernd J. Schmitz-Dräger; Goce Spasovski; Jan A. Staessen; Dimitrios Stamatialis; Peter Stenvinkel; Christoph Wanner; Stephen B. Williams; Faiez Zannad; Carmine Zoccali; Raymond Vanholder. 2021. "Data Sharing Under the General Data Protection Regulation." Hypertension 77, no. 4: 1029-1035.

Review
Published: 06 March 2021 in Children
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Child and adolescent obesity constitute one of the greatest contemporary public health menaces. The enduring disproportion between calorie intake and energy consumption, determined by a complex interaction of genetic, epigenetic, and environmental factors, finally leads to the development of overweight and obesity. Child and adolescent overweight/obesity promotes smoldering systemic inflammation (“para-inflammation”) and increases the likelihood of later metabolic and cardiovascular complications, including metabolic syndrome and its components, which progressively deteriorate during adulthood. Exosomes are endosome-derived extracellular vesicles that are secreted by a variety of cells, are naturally taken-up by target cells, and may be involved in many physiological and pathological processes. Over the last decade, intensive research has been conducted regarding the special role of exosomes and the non-coding (nc) RNAs they contain (primarily micro (mi) RNAs, long (l) non-coding RNAs, messenger (m) RNAs and other molecules) in inter-cellular communications. Through their action as communication mediators, exosomes may contribute to the pathogenesis of obesity and associated disorders. There is increasing evidence that exosomal miRNAs and lncRNAs are involved in pivotal processes of adipocyte biology and that, possibly, play important roles in gene regulation linked to human obesity. This review aims to improve our understanding of the roles of exosomes and their cargo in the development of obesity and related metabolic and inflammatory disorders. We examined their potential roles in adipose tissue physiology and reviewed the scarce data regarding the altered patterns of circulating miRNAs and lncRNAs observed in obese children and adolescents, compared them to the equivalent, more abundant existing findings of adult studies, and speculated on their proposed mechanisms of action. Exosomal miRNAs and lncRNAs could be applied as cardiometabolic risk biomarkers, useful in the early diagnosis and prevention of obesity. Furthermore, the targeting of crucial circulating exosomal cargo to tissues involved in the pathogenesis and maintenance of obesity could provide a novel therapeutic approach to this devastating and management-resistant pandemic.

ACS Style

Ioanna Maligianni; Christos Yapijakis; Flora Bacopoulou; George Chrousos. The Potential Role of Exosomes in Child and Adolescent Obesity. Children 2021, 8, 196 .

AMA Style

Ioanna Maligianni, Christos Yapijakis, Flora Bacopoulou, George Chrousos. The Potential Role of Exosomes in Child and Adolescent Obesity. Children. 2021; 8 (3):196.

Chicago/Turabian Style

Ioanna Maligianni; Christos Yapijakis; Flora Bacopoulou; George Chrousos. 2021. "The Potential Role of Exosomes in Child and Adolescent Obesity." Children 8, no. 3: 196.

Review
Published: 26 February 2021 in Nutrients
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Obesity represents one of the most challenging public health problems of our century. It accounts for approximately 5% of deaths worldwide, mostly owing to cardiovascular disease and its associated complications. Cardiovascular noninvasive imaging may provide early accurate information about hypertrophy and ischemia/fibrosis in obese subjects. Echocardiography and nuclear cardiology have serious limitations in obese subjects owing to poor acoustic window and attenuation artifacts, respectively. Coronary computed tomography angiography can provide information about obstructive coronary disease; however, the use of radiation is a serious disadvantage. Finally, cardiac magnetic resonance (CMR) holds the promise of an “all in one” examination by combining evaluation of function, wall motion/thickness, stress rest/perfusion, replacement and diffuse fibrosis without radiation. Future studies are required to document the cost/benefit ratio of the CMR in the evaluation of cardiovascular risk in overweight/obese children and adolescents.

ACS Style

Sophie Mavrogeni; Flora Bacopoulou; George Markousis-Mavrogenis; George Chrousos; Evangelia Charmandari. Cardiovascular Imaging in Obesity. Nutrients 2021, 13, 744 .

AMA Style

Sophie Mavrogeni, Flora Bacopoulou, George Markousis-Mavrogenis, George Chrousos, Evangelia Charmandari. Cardiovascular Imaging in Obesity. Nutrients. 2021; 13 (3):744.

Chicago/Turabian Style

Sophie Mavrogeni; Flora Bacopoulou; George Markousis-Mavrogenis; George Chrousos; Evangelia Charmandari. 2021. "Cardiovascular Imaging in Obesity." Nutrients 13, no. 3: 744.

Review article
Published: 18 February 2021 in Translational Psychiatry
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The pervasive and frequently devastating nature of aggressive behavior calls for a collective effort to understand its psychosocial and neurobiological underpinnings. Regarding the latter, diverse brain areas, neural networks, neurotransmitters, hormones, and candidate genes have been associated with antisocial and aggressive behavior in humans and animals. This review focuses on the role of monoamine oxidases (MAOs) and the genes coding for them, in the modulation of aggression. During the past 20 years, a substantial number of studies using both pharmacological and genetic approaches have linked the MAO system with aggressive and impulsive behaviors in healthy and clinical populations, including the recent discovery of MAALIN, a long noncoding RNA (lncRNA) regulating the MAO-A gene in the human brain. Here, we first provide an overview of the MAOs and their physiological functions, we then summarize recent key findings linking MAO-related enzymatic and gene activity and aggressive behavior, and, finally, we offer novel insights into the mechanisms underlying this association. Using the existing experimental evidence as a foundation, we discuss the translational implications of these findings in clinical practice and highlight what we believe are outstanding conceptual and methodological questions in the field. Ultimately, we propose that unraveling the specific role of MAO in aggression requires an integrated approach, where this question is pursued by combining psychological, radiological, and genetic/genomic assessments. The translational benefits of such an approach include the discovery of novel biomarkers of aggression and targeting the MAO system to modulate pathological aggression in clinical populations.

ACS Style

Alexios-Fotios A. Mentis; Efthimios Dardiotis; Eleni Katsouni; George P. Chrousos. From warrior genes to translational solutions: novel insights into monoamine oxidases (MAOs) and aggression. Translational Psychiatry 2021, 11, 1 -11.

AMA Style

Alexios-Fotios A. Mentis, Efthimios Dardiotis, Eleni Katsouni, George P. Chrousos. From warrior genes to translational solutions: novel insights into monoamine oxidases (MAOs) and aggression. Translational Psychiatry. 2021; 11 (1):1-11.

Chicago/Turabian Style

Alexios-Fotios A. Mentis; Efthimios Dardiotis; Eleni Katsouni; George P. Chrousos. 2021. "From warrior genes to translational solutions: novel insights into monoamine oxidases (MAOs) and aggression." Translational Psychiatry 11, no. 1: 1-11.

Journal article
Published: 03 February 2021 in JMIR Formative Research
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Background The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects.

ACS Style

Styliani Geronikolou; George Chrousos. COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results. JMIR Formative Research 2021, 5, e21156 .

AMA Style

Styliani Geronikolou, George Chrousos. COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results. JMIR Formative Research. 2021; 5 (2):e21156.

Chicago/Turabian Style

Styliani Geronikolou; George Chrousos. 2021. "COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results." JMIR Formative Research 5, no. 2: e21156.

Correspondence
Published: 28 January 2021 in Intensive Care Medicine
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G. Umberto Meduri; George P. Chrousos; Yaseen M. Arabi. The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Author's reply. Intensive Care Medicine 2021, 47, 357 -358.

AMA Style

G. Umberto Meduri, George P. Chrousos, Yaseen M. Arabi. The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Author's reply. Intensive Care Medicine. 2021; 47 (3):357-358.

Chicago/Turabian Style

G. Umberto Meduri; George P. Chrousos; Yaseen M. Arabi. 2021. "The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Author's reply." Intensive Care Medicine 47, no. 3: 357-358.

Journal article
Published: 24 January 2021 in Nutrients
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Childhood overweight and obesity prevalence has risen dramatically in the past decades, and family-based interventions may be an effective method to improve children’s eating behaviors. This study aimed to evaluate the effectiveness of three different family-based interventions: group-based, individual-based, or by website approach. Parents and school aged overweight or obese children, 8–12 years of age, were eligible for the study. A total of 115 children were randomly allocated in one of the three interventions, and 91 completed the study (79% compliance); Group 1 (n = 36) received group-based interventions by various experts; Group 2 (n = 30) had interpersonal family meetings with a dietitian; and Group 3 (n = 25) received training through a specifically developed website. Anthropometric, dietary, physical activity, and screen time outcomes were measured at baseline and at the end of the study. Within-group comparisons indicated significant improvement in body weight, body mass index (BMI)-z-score, physical activity, and screen time from baseline in all three study groups (p < 0.05). Furthermore, total body fat percentage (%TBF) was also decreased in Groups 2 and 3. Between-group differences varied with body weight and %TBF change, being larger in Group 3 compared to Groups 1 and 2, in contrast to BMI-z-score, screen time, and health behaviors, which were significantly larger in Group 2 than the other two groups. In conclusion, personalized family-based interventions are recommended to successfully improve children’s lifestyle and body weight status.

ACS Style

Panagiotis Varagiannis; Emmanuella Magriplis; Grigoris Risvas; Katerina Vamvouka; Adamantia Nisianaki; Anna Papageorgiou; Panagiota Pervanidou; George Chrousos; Antonis Zampelas. Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The “4 Your Family” Randomized Controlled Trial. Nutrients 2021, 13, 341 .

AMA Style

Panagiotis Varagiannis, Emmanuella Magriplis, Grigoris Risvas, Katerina Vamvouka, Adamantia Nisianaki, Anna Papageorgiou, Panagiota Pervanidou, George Chrousos, Antonis Zampelas. Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The “4 Your Family” Randomized Controlled Trial. Nutrients. 2021; 13 (2):341.

Chicago/Turabian Style

Panagiotis Varagiannis; Emmanuella Magriplis; Grigoris Risvas; Katerina Vamvouka; Adamantia Nisianaki; Anna Papageorgiou; Panagiota Pervanidou; George Chrousos; Antonis Zampelas. 2021. "Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The “4 Your Family” Randomized Controlled Trial." Nutrients 13, no. 2: 341.

Review
Published: 18 January 2021 in International Journal of Environmental Research and Public Health
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Adolescent suse internet via several devices to gather information or communicate. Sleep, as a key factor of adolescents’ development, contributes to their physical and mental health. Over the past decades insufficient sleep among adolescents has been wide spread, and one of its attributing factors is the increased availability of technology. This review aims to investigate the body of evidence regarding the impact of problematic internet use on adolescent sleep. Extensive search of databases was performed according to PRISMA guidelines for studies published within the last decade, regarding subjects aged 10–19. The final step of the search yielded 12 original studies. The quality of extracted data was evaluated with the AXIS tool, in order to estimate the risk of bias. All studies showed a negative correlation between adolescent sleep and problematic internet use. It was found to affect sleep quality and quantity and provoke insomnia symptoms. Interestingly, adolescent’s sex, parental educational level, type of family and use for leisure or academic reasons appeared as affecting factors of the problematic internet use-sleep relationship. Problematic internet use has several effects on adolescents’ sleep. Results of relevant studies should be embedded in educational interventions addressed to adolescents as well as parents, to eliminate the negative outcomes of problematic internet use on sleep and adolescence’s health in general.

ACS Style

Ioulia Kokka; Iraklis Mourikis; Nicolas Nicolaides; Christina Darviri; George Chrousos; Christina Kanaka-Gantenbein; Flora Bacopoulou. Exploring the Effects of Problematic Internet Use on Adolescent Sleep: A Systematic Review. International Journal of Environmental Research and Public Health 2021, 18, 760 .

AMA Style

Ioulia Kokka, Iraklis Mourikis, Nicolas Nicolaides, Christina Darviri, George Chrousos, Christina Kanaka-Gantenbein, Flora Bacopoulou. Exploring the Effects of Problematic Internet Use on Adolescent Sleep: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18 (2):760.

Chicago/Turabian Style

Ioulia Kokka; Iraklis Mourikis; Nicolas Nicolaides; Christina Darviri; George Chrousos; Christina Kanaka-Gantenbein; Flora Bacopoulou. 2021. "Exploring the Effects of Problematic Internet Use on Adolescent Sleep: A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 2: 760.

Review
Published: 13 January 2021 in BMC Medicine
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Background The etiologies of chronic neurological diseases, which heavily contribute to global disease burden, remain far from elucidated. Despite available umbrella reviews on single contributing factors or diseases, no study has systematically captured non-purely genetic risk and/or protective factors for chronic neurological diseases. Methods We performed a systematic analysis of umbrella reviews (meta-umbrella) published until September 20th, 2018, using broad search terms in MEDLINE, SCOPUS, Web of Science, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations & Theses, JBI Database of Systematic Reviews and Implementation Reports, DARE, and PROSPERO. The PRISMA guidelines were followed for this study. Reference lists of the identified umbrella reviews were also screened, and the methodological details were assessed using the AMSTAR tool. For each non-purely genetic factor association, random effects summary effect size, 95% confidence and prediction intervals, and significance and heterogeneity levels facilitated the assessment of the credibility of the epidemiological evidence identified. Results We identified 2797 potentially relevant reviews, and 14 umbrella reviews (203 unique meta-analyses) were eligible. The median number of primary studies per meta-analysis was 7 (interquartile range (IQR) 7) and that of participants was 8873 (IQR 36,394). The search yielded 115 distinctly named non-genetic risk and protective factors with a significant association, with various strengths of evidence. Mediterranean diet was associated with lower risk of dementia, Alzheimer disease (AD), cognitive impairment, stroke, and neurodegenerative diseases in general. In Parkinson disease (PD) and AD/dementia, coffee consumption, and physical activity were protective factors. Low serum uric acid levels were associated with increased risk of PD. Smoking was associated with elevated risk of multiple sclerosis and dementia but lower risk of PD, while hypertension was associated with lower risk of PD but higher risk of dementia. Chronic occupational exposure to lead was associated with higher risk of amyotrophic lateral sclerosis. Late-life depression was associated with higher risk of AD and any form of dementia. Conclusions We identified several non-genetic risk and protective factors for various neurological diseases relevant to preventive clinical neurology, health policy, and lifestyle counseling. Our findings could offer new perspectives in secondary research (meta-research).

ACS Style

Alexios-Fotios A. Mentis; Efthimios Dardiotis; Vasiliki Efthymiou; George P. Chrousos. Non-genetic risk and protective factors and biomarkers for neurological disorders: a meta-umbrella systematic review of umbrella reviews. BMC Medicine 2021, 19, 1 -28.

AMA Style

Alexios-Fotios A. Mentis, Efthimios Dardiotis, Vasiliki Efthymiou, George P. Chrousos. Non-genetic risk and protective factors and biomarkers for neurological disorders: a meta-umbrella systematic review of umbrella reviews. BMC Medicine. 2021; 19 (1):1-28.

Chicago/Turabian Style

Alexios-Fotios A. Mentis; Efthimios Dardiotis; Vasiliki Efthymiou; George P. Chrousos. 2021. "Non-genetic risk and protective factors and biomarkers for neurological disorders: a meta-umbrella systematic review of umbrella reviews." BMC Medicine 19, no. 1: 1-28.