European University Cyprus

This systematic review aims to reassess the expanding role of the cerebellum in pain perception , challenging its traditional and simplis-tic association with the motor domain. Pain perception is a complex experience shaped by sensory, emotional, and cognitive factors, with recent findings underlining the cerebel-lum's influence over these systems. This paper evaluates findings from 24 relevant studies to elucidate key findings with regard to pain and their potential clinical applications. The cerebel-lum's role in pain processing is assessed through its interaction with nociceptive pathways, pain anticipation, and the intonation of pain-related emotional responses. Key cerebellar regions such as Crus I, lobules VI and VIII, and the vermis, are persistently activated during pain perception and anticipation. These regions are linked to sensory-discriminative and affective-moti-vational elements of pain. Studies on patients with migraines, chronic low back pain, and irritable bowel syndrome (IBS) demonstrated increased cerebellar activation, suggesting its role in chronic pain conditions. Non-invasive neurostimulation techniques, such as transcra-nial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), administered onto these cerebellar regions, show potential in modulation of pain and clinical application. Future research should aim to standardise methodologies, explore the cerebel-lum's role in acute pain, and investigate long-term effects of cerebellar-targeted treatments. Understanding the cerebellum's multifaceted role in pain perception can advance diagnostic and therapeutic strategies, offering a more comprehensive approach to pain management. This review underscores the need for further investigation into cerebellar mechanisms and their Cyprus Pain Ther clinical applications, potentially transforming pain treatment paradigms.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with diverse clinical manifestations. While small vessel vasculitis is a common SLE complication, lupus aortitis is an exceedingly rare entity with limited documentation. Here, we report a novel case of lupus aortitis misleadingly appearing on imaging studies as an aortic intramural hematoma in a 68-year-old male. The patient initially exhibited fatigue, dyspnea, and pericardial effusion. Imaging studies suggested an intramural hematoma of the ascending aorta and the aortic arch, prompting urgent surgical exploration. Intraoperative findings revealed a thickened, fibrotic, and heavily calcified aorta (egg-shell aorta) without hematoma. Subsequent histopathological and immunological analyses confirmed lupus aortitis. This case underscores the diagnostic challenges posed by this rare SLE complication, which can mimic other aortic pathologies. Early recognition and individualized treatment are paramount. Further studies are needed to elucidate its pathophysiology and establish standardized management guidelines.

Background Recent advances in molecular oncology have increasingly illuminated the role of germline EGFR mutations in non-small cell lung cancer (NSCLC). This case report presents the presence of a unique familial occurrence of EGFR mutations in patients with NSCLC. Case description A mother and son, both never-smokers of Caucasian ethnicity, were diagnosed with advanced metastatic lung adenocarcinoma. In one patient, tumor molecular analysis by next generation sequencing (NGS) identified two EGFR mutations: the activating mutation c.2573T > G; p.Leu858Arg (p.L858R) in exon 21 of the EGFR gene, and the somatic non-pathogenic mutation c.2612 C > A; p.Ala871Glu (p.A871E) in exon 21 of the EGFR gene. The second patient also harbored the same two EGFR mutations. The patient underwent genetic testing which revealed the germline origin of the A871E mutation. Whether the presence of this mutations was associated with increased predisposition to cancer has yet to be determined. Our case report highlights the need for further exploration of the role of germline mutations, including the A871E mutation, in tumorigenesis and its implications for treatment response and inheritance patterns. Conclusions The investigation and comprehension of the significance of each individual EGFR mutation hold the promise for potential in cancer prevention or early diagnosis within family cohorts and understanding the mechanisms of tumorigenesis in sporadic cases.

Taylor Spatial Frame (TSF) is a type of hexapod external ring fixation system. TSF rings are supplied as half rings, whole full rings and two third rings in different sizes. In this work, these components as well as bolted full rings made of two half rings were tested in compression in two or three directions. Tests were simulated by Finite Element (FE) method using 3D solid elements, which were validated against the experimental results. Load-deflection curves and values for stiffness and ultimate loads are presented for each case from both tests and FE analyses. Load-stiffness curves are also presented for each test. The followings were demonstrated by the results: (1) a significant difference between bolted and whole full rings in their respective stiffness behaviour, the clear advantage being with the whole full rings, (2) a variation in stiffness of bolted rings when loaded across their different diameters, (3) a potential problem in the TSF rings: having the same cross section and thickness, smaller rings are stronger than larger ones, whereas in fact the larger ones ought to be stronger due to patient’s weight and that (4) the lowest stiffness was exhibited when a 2/3 ring was loaded parallel to the line joining its open ends.

Various epidemiological datasets and pathophysiological hypotheses have highlighted a significant link between chronic kidney disease (CKD) and cognitive impairment (CI); each condition can potentially exacerbate the other. Here, we review the mutual consequences of CKD and CI on health outcomes and care pathways and highlight the complexities due to the involvement of different specialists. Our narrative review covers (i) the burden of CI among patients with CKD, (ii) the impact of CI on kidney health, (iii) access to kidney replacement therapy for people with CI, (iv) resources in cognitive care and (v) potential models for integrated ‘nephro-cognitive’ care. CI (ranging from mild CI to dementia) has a significant impact on older adults, with a high prevalence and a strong association with CKD. Furthermore, CI complicates the management of CKD and leads to a higher mortality rate, poorer quality of life and higher healthcare costs. Due to difficulties in symptom description and poor adherence to medical guidelines, the presence of CI can delay the treatment of CKD. Access to care for patients with both CKD and CI is hindered by physical, cognitive and systemic barriers, resulting in less intensive, less timely care. Multidisciplinary approaches involving nephrologists, geriatricians, neurologists and other specialists are crucial. Integrated care models focused on person-centred approaches, shared decision-making and continuous co-management may improve outcomes. Future research should focus on the putative beneficial effects of these various strategies on both clinical and patient-reported outcomes.

State-of-the-art climate models project a substantial decline in precipitation for the Mediterranean region in the future¹. Supporting this notion, several studies based on observed precipitation data spanning recent decades have suggested a decrease in Mediterranean precipitation2, 3–4, with some attributing a large fraction of this change to anthropogenic influences3,5. Conversely, certain researchers have underlined that Mediterranean precipitation exhibits considerable spatiotemporal variability driven by atmospheric circulation patterns6,7 maintaining stationarity over the long term8,9. These conflicting perspectives underscore the need for a comprehensive assessment of precipitation changes in this region, given the profound social, economic and environmental implications. Here we show that Mediterranean precipitation has largely remained stationary from 1871 to 2020, albeit with significant multi-decadal and interannual variability. This conclusion is based on the most comprehensive dataset available for the region, encompassing over 23,000 stations across 27 countries. While trends can be identified for some periods and subregions, our findings attribute these trends primarily to atmospheric dynamics, which would be mostly linked to internal variability. Furthermore, our assessment reconciles the observed precipitation trends with Coupled Model Intercomparison Project Phase 6 model simulations, neither of which indicate a prevailing past precipitation trend in the region. The implications of our results extend to environmental, agricultural and water resources planning in one of the world’s prominent climate change hotspots¹⁰.

Background Dental education aims to equip students with the knowledge and skills required to competently manage clinical scenarios. It is critical that dental education evolves with technological advances to ensure quality student preparation. New technologies such as three‐dimensional printing (3DP) have found their way into dental education and could overcome the limitations of traditional methods. The question arises: Is 3DP suitable to replace the current conventional educational modalities in preclinical dental education? Methods A review of the current literature was conducted in September 2024 to identify the use of 3DP models in various dental disciplines for predoctoral education. The outcomes of the retrieved records were analyzed as subjective measurements or objective assessments by the participants. Results The initial search yielded 776 articles, of which 24 studies were eventually considered for qualitative synthesis. The dental disciplines in which 3DP was used in preclinical education were operative dentistry, prosthodontics, endodontics, maxillofacial surgery, and pediatric dentistry, with a maximum of seven studies in operative dentistry and a minimum of one in pediatric dentistry. In all studies, 3DP models were used in comparison to conventional typodonts, human‐extracted teeth, cadaver models, or virtual reality simulators, as dictated by the university's curriculum. Conclusions 3DP models can benefit preclinical education by creating different case scenarios that resemble real‐life situations. They also offer greater availability and cost‐effectiveness. However, further research and material development is needed to improve the tactile sensation of the models to better resemble dental tissues.

Background The 17q21.31 region with various structural forms characterized by the H1/H2 haplotypes and three large copy number variations (CNVs) represents the strongest risk locus in progressive supranuclear palsy (PSP). Objective To investigate the association between CNVs and structural forms on 17q.21.31 with the risk of PSP. Methods Utilizing whole genome sequencing data from 1684 PSP cases and 2392 controls, the three large CNVs (α, β, and γ) and structural forms within 17q21.31 were identified and analyzed for their association with PSP. Results We found that the copy number of γ was associated with increased PSP risk (odds ratio [OR] = 1.10, P = 0.0018). From H1β1γ1 (OR = 1.21) and H1β2γ1 (OR = 1.24) to H1β1γ4 (OR = 1.57), structural forms of H1 with additional copies of γ displayed a higher risk for PSP. The frequency of the risk sub‐haplotype H1c rises from 1% in individuals with two γ copies to 88% in those with eight copies. Additionally, γ duplication up‐regulates expression of ARL17B , LRRC37A / LRRC37A2 , and NSFP1 , while down‐regulating KANSL1 . Single‐nucleus RNA‐seq of the dorsolateral prefrontal cortex analysis reveals γ duplication primarily up‐regulates LRRC37A / LRRC37A2 in neuronal cells. Conclusions The copy number of γ is associated with the risk of PSP after adjusting for H1/H2, indicating that the complex structure at 17q21.31 is an important consideration when evaluating the genetic risk of PSP. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background: Data standards are not only key to making data processing efficient but also fundamental to ensuring data interoperability. When clinical trial data are structured according to international standards, they become significantly easier to analyze, reducing the efforts required for data cleaning, preprocessing, and secondary use. A common language and a shared set of expectations facilitate interoperability between systems and devices. Objective: The main objectives of this study were to identify commonalities and differences in clinical trial metadata, protocols, and data collection systems/items within the VACCELERATE project. Methods: To assess the degree of interoperability achieved in the project and suggest methodological improvements, interoperable points were identified based on the core outcome areas—immunogenicity, safety, and efficacy (clinical/physiological). These points were emphasized in the development of the master protocol template and were manually compared in the following ways: (1) summaries, objectives, and end points in the protocols of 3 VACCELERATE clinical trials (EU-COVAT-1_AGED, EU-COVAT-2_BOOSTAVAC, and EU-COVPT-1_CoVacc) against the master protocol template; (2) metadata of all 3 clinical trials; and (3) evaluations from a questionnaire survey regarding differences in data management systems and structures that enabled data exchange within the VACCELERATE network. Results: The noncommonalities identified in the protocols and metadata were attributed to differences in populations, variations in protocol design, and vaccination patterns. The detailed metadata released for all 3 vaccine trials were clearly structured using internal standards, terminology, and the general approach of Clinical Data Acquisition Standards Harmonisation (CDASH) for data collection (e.g., on electronic case report forms). VACCELERATE benefited significantly from the selection of the Clinical Trials Centre Cologne as the sole data management provider. With system database development coordinated by a single individual and no need for coordination among different trial units, a high degree of uniformity was achieved automatically. The harmonized transfer of data to all sites, using well-established methods, enabled quick exchanges and provided a relatively secure means of data transfer. Conclusions: This study demonstrated that using master protocols can significantly enhance trial operational efficiency and data interoperability, provided that similar infrastructure and data management procedures are adopted across multiple trials. To further improve data interoperability and facilitate interpretation and analysis, shared data should be structured, described, formatted, and stored using widely recognized data and metadata standards.

T cells play diverse roles in cancer immunology, acting as tumor suppressors, cytotoxic effectors, enhancers of cytotoxic T lymphocyte responses and immune suppressors; providing memory and surveillance; modulating the tumor microenvironment (TME); or activating innate immune cells. However, cancer cells can disrupt T cell function, leading to T cell exhaustion and a weakened immune response against the tumor. The expression of exhausted T cell (Tex) markers plays a pivotal role in shaping the immune landscape of multiple cancers. Our aim was to systematically investigate the role of known T cell exhaustion (Tex) markers across multiple cancers while exploring their molecular interactions, mutation profiles, and potential implications for immunotherapy. The mRNA expression profile of six Tex markers, LAG-3, PDCD1, TIGIT, HAVCR2, CXCL13, and LAYN was investigated in pan-cancer. Utilizing data from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), The Cancer Proteome Atlas (TCPA), and other repositories, we characterized the differential expression of the Tex markers, their association with the patients’ survival outcome, and their mutation profile in multiple cancers. Additionally, we analyzed the effects on cancer-related pathways and immune infiltration within the TME, offering valuable insights into mechanisms of cancer immune evasion and progression. Finally, the correlation between their expression and sensitivity to multiple anti-cancer drugs was investigated extensively. Differential expression of all six markers was significantly associated with KIRC and poor prognosis in several cancers. They also played a potential activating role in apoptosis, EMT, and hormone ER pathways, as well as a potential inhibitory role in the DNA damage response and RTK oncogenic pathways. Infiltration of different immune cells was also found to be associated with the expression of the Tex-related genes in most cancer types. These findings underline that the reviving of exhausted T cells can be used to enhance the efficacy of immunotherapy in cancer patients.

An increasing number of studies have shown the impact of social determinants of health (SDoHs) on different cardiovascular outcomes. SDoHs influence the regional incidence of heart failure, heart failure outcomes, and heart failure readmission rates; can prevent use of advanced heart failure therapies in minorities with an indication for their use; can influence the incidence of coronary artery disease and peripheral artery disease outcomes; and can also prevent providing equal quality of care to all patients with myocardial infarction. In the setting of arrhythmias, specific SDoHs can increase the incidence of atrial fibrillation and adversely affect major outcomes in these patients. In congenital heart diseases, SDoHs can affect major outcomes, as well. In conclusion, SDoHs significantly impact cardiovascular morbidity and death and specific outcomes of patients with cardiovascular disease. Policy measures that aim to improve those SDoHs that negatively affect health outcomes hold promise for improving cardiovascular outcomes at individual and population levels.

Vision impairment is common among older adults and affects dementia screening assessments, which include visually presented items. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with vision impairment that includes all the cognitive domains included in the standard MoCA. Visual components of the MoCA were adapted by developing alternative spoken forms. We used both individual item analysis and item substitution to identify the optimal set of alternative items for inclusion in the Montreal Cognitive Assessment for People With Vision Impairment (MoCA-VI) in place of the original items to maximize sensitivity and specificity for dementia. We evaluated the performance and reliability of the final tool, including adjustments for demographic factors. One hundred twenty-eight participants with vision impairment (presenting distance visual acuity worse than 6/12), 79 cognitively healthy and 49 with dementia, completed the adapted MoCA. An additional 86 participants with normal vision completed the standard MoCA and alternative items to assess score equivalence and independence from vision impairment. Twenty-six participants were retested 2–4 weeks after initial testing. With the optimal item set, the final MoCA-VI had an area under the curve of 0.96 (95% CI [0.93, 0.99]). At a cut point of 24 points or less, sensitivity was 95.9%, with a specificity of 92.4%. The intraclass correlation for test–retest reliability was 0.84 (95% CI [0.81, 0.96]). The MoCA-VI is a specific and reliable test for possible dementia among adults with vision impairment.

sec> BACKGROUND Asthma and allergies are the most frequent chronic diseases among children. We have assessed the prevalence of asthma and allergies in European schoolchildren who participated in the SINPHONIE (Schools Indoor Pollution and Health-Observatory Network in Europe) project, accounting for geographical differences. METHODS We analysed questionnaires from parents and guardians of 4,899 schoolchildren aged 6-14 from 54 cities in 23 European countries in 2011–2012. Logistic regression models were used to estimate adjusted prevalence rates of symptoms/diseases and associations among symptoms/diseases and geographical clusters (Northern Europe [NE] as reference). RESULTS Higher odd ratios (ORs) were found for eczema in Western Europe (WE) (OR 1.4) and Central-Eastern Europe (CEE) (OR 1.4); and dry cough at night in WE (OR 1.6), CEE (OR 1.7) and Southern Europe (SE) (OR 2.6). Lower ORs were observed for eczema in SE (OR 0.8), allergic rhinitis in WE (OR 0.6), cat/dog hypersensitivity/allergy in WE (OR 0.4), CEE (OR 0.6) and SE (OR 0.5); pollen hypersensitivity/allergy in WE (OR 0.6); asthma in CEE (OR 0.7); any drug for asthma in WE (OR 0.6), CEE (OR 0.7) and SE (OR 0.7); wheezing/whistling in WE (OR 0.6); cough on most days in WE (OR 0.5) and SE (OR 0.6); phlegm on most days in WE (OR 0.5); sneezing/runny/blocked nose in WE (OR 0.8). CONCLUSIONS The frequency of asthma/allergies in European children varies widely geographically. This variability should be considered for preventive purposes.</sec

This study investigates the intra-and interrater reliability of Pressure Pain Threshold assessments in patients with non-specific shoulder pain, focusing on chronic and subacute stages. A sample of 26 adults was evaluated using a mechanical algometer across six anatomical points. Intrarater and interrater reliability were calculated using the intraclass correlation coefficient (ICC), standard error of measurement, and minimal detectable change (MDC). Results demonstrated almost perfect reliability for both intrarater (ICC range: 0.96-0.99) and interrater (ICC range: 0.92-0.99) assessments. Standard error of measurement and MDC values for intrarater reliability showed clinically acceptable error, except for the upper trapezius and mid-deltoid, where MDC value exceeded 25% of the grand mean, suggesting reduced precision between nonspecific shoulder pain stages. For interrater reliability, the adductor pollicis brevis, upper trapezius, and infraspinatus also showed less precision, with MDC values exceeding 25% of the grand mean, particularly in chronic patients. Despite these findings, no significant differences were observed between the subacute and chronic groups. While relative reliability was high, the findings highlight the need for caution in interpreting absolute reliability, especially for inter-rater assessments at specific muscle sites.

The Greek State’s involvement in international space law (ISL) is considered to have begun with its membership in the International Telecommunication Union (ITU) as a founding member in 1865, although the ITU’s focus on space-related matters emerged much later. In reality, Greece’s active engagement in space matters started in the 1970s with the ratification of key ISL treaties, including the Outer Space Treaty. This was followed by its accession to major ISL organizations and managemenet systems –such as mainly the UN COPUOS, INTELSAT, and INMARSAT– in the 1980s. Within this framework, Greece played a significant role in shaping space law, such as by co-sponsoring proposals addressing key regulatory issues. Additionally, it demonstrated a strong commitment to both binding treaties and non-binding soft law instruments, highlighting the importance of international guidelines. This engagement underscores Greece’s recognition of reliable space infrastructure and sustainable space activity as crucial priorities, facilitated through its collaboration with organizations like the European Space Agency and its involvement in international space programs.

This chapter explores Greece’s progression in EU space-related activities and law, tracing its journey from regional (EU) engagement to establishing a domestic space sector and legal framework. Initially, Greece gained knowledge by participating in major European space organizations and programs, such as EUTELSAT and EUMETSAT, which facilitated access to operational satellite services. Notably, Greece’s collaboration with the European Space Agency (ESA) began in the 1990s, culminating in full membership in 2005. Such collaborations allowed the Greek State to also integrate into European space initiatives, leveraging expertise to support national capabilities. In parallel, Greece aligned with EU space policies, marked by its initiation of satellite launches in the early 2000s, taking key steps to enhance its space capabilities and support regional connectivity. By 2017, Greece enacted its national space law, and established the Hellenic Space Agency (later the Hellenic Space Center), underscoring its commitment to space exploration, research, and governance. This milestone reinforced its role in contributing to EU space strategies while simultaneously advancing its domestic capabilities.

This chapter examines the substantive legal rules established in Greece’s 2017 Space Law (Law no 4508/2017), which provide a comprehensive and structured framework for regulating space activities conducted under Greek jurisdiction. Section 5.1 defines the law’s territorial, personal, and material scope, clarifying key terms such as “space activity”, “space object” and “operator,” ensuring alignment with international space law and providing the basis for its application. Section 5.2 details the authorization process, emphasizing adherence to legal, technical, and environmental standards, and elaborates on rules governing the supervision, transfer, and termination of space activities to ensure operational compliance. Section 5.3 examines risk management in space operations, addressing ex-ante obligations like reporting, as well as ex-post liability and compensation mechanisms, including provisions for unauthorized activities and transitional measures to mitigate risks. Section 5.4 focuses on tracking, registering, and recovering space objects, outlining responsibilities to maintain national registries, notify the UN competent authority, and manage re-entry processes, with an emphasis on safety, regulatory clarity, and international collaboration. Collectively, the law strengthens Greece’s regulatory framework, fostering compliance with global standards while promoting secure and sustainable space governance.

This study presented the principal developments in Greek space law and highlighted Greece’s expanding role in the space sector, encompassing legislative, policy, and scientific dimensions. Significant progress is evident through Greece’s collaboration with European and international organizations, its accession to the Artemis Accords, and notable scientific advancements. For example, through strategic partnerships between the National Observatory of Athens (NOA) and the European Space Agency (ESA), several key achievements have been realized, including the successful evaluation of NOA’s Aristarchus 2.3m telescope by ESA, which has been selected as the first European Optical Ground Station (OGS) for optical satellite communications under the ARTES/Scylight program. Additional accomplishments include NOA’s involvement in the emblematic Psyche NASA mission to the asteroid 16-Psyche and its collaboration with HellasSat, Greece’s national satellite provider, in optics and quantum communications. These initiatives collectively underscore the dynamic evolution of the Greek space sector and reflect the country’s growing capabilities.