The effect of disability and gender mediated by depression on health-related quality of life of Greek stroke patients in the subacute rehabilitation phase: a prospective cohort study.

Background: Stroke has been associated with compromised patient outcomes, such as a decreased quality of life. We aimed in the present study to evaluate the health-related quality of life (HRQοL) of hospitalized Greek stroke patients during the sub-acute rehabilitation period and assess the effect of demographic and clinical characteristics mediated by depressive symptom severity on HRQοL. Methods: In a prospective study, a cohort of adult patients hospitalized in the sub-acute phase of their first stroke episode were assessed in the Rehabilitation Clinic of the University Hospital of Ioannina in Greece. Patients' functional status, depressive symptom severity, and HRQοL were evaluated twice, using the Patient Health Questionnaire 9 (PHQ-9), the Barthel Index (BI), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), respectively. All patients received physical, occupational, and speech therapy during their rehabilitation. Results: Fifty consecutive adult stroke patients were enrolled. We detected a statistically significant (p <0.001) improvement in WHOQOL-BREF, especially in the "psychological health" and "environment" domains, BI, and PHQ-9 scores, between the initial and follow-up assessments. Mediation analysis revealed that baseline disability had both a significant direct (estimate =0.014, p <0.001) and indirect (estimate =0.010, p <0.001, PHQ-9 as mediator) effect on the total HRQoL score. Gender and stroke localization had significant direct effects on HRQoL total (estimate =-0.432, p =0.009, and estimate =0.395, p =0.031, respectively), while PHQ-9 mediation was insignificant. Antidepressant medications and stroke type did not play a substantial role in HRQoL. Conclusion: By the end of the subacute rehabilitation phase, patients' HRQoL, functionality and depression severity improved. Additionally, baseline functionality, stroke localization, and gender directly or indirectly (mediated by initial depression severity) affected HRQoL, with male patients and patients with stroke non-involving the frontal lobe/basal ganglia showing a better HRQoL by the end of rehabilitation. HIPPOKRATIA 2023, 27 (1):12-17.

Atmospheric dynamics. Constrained work output of the moist atmospheric heat engine in a warming climate.

Incoming and outgoing solar radiation couple with heat exchange at Earth's surface to drive weather patterns that redistribute heat and moisture around the globe, creating an atmospheric heat engine. Here, we investigate the engine's work output using thermodynamic diagrams computed from reanalyzed observations and from a climate model simulation with anthropogenic forcing. We show that the work output is always less than that of an equivalent Carnot cycle and that it is constrained by the power necessary to maintain the hydrological cycle. In the climate simulation, the hydrological cycle increases more rapidly than the equivalent Carnot cycle. We conclude that the intensification of the hydrological cycle in warmer climates might limit the heat engine's ability to generate work.

Cyclosporin A and tissue antigen matching in bone transplantation. Fibular allografts studied in the dog.

We studied the mechanical, metabolic, and histologic properties of short-term nonvascularized cortical bone grafts in a canine fibular graft model. Sham operated nonvascularized autotransplanted and allotransplanted bones were compared. The allografts were performed between dog leukocyte antigen (DLA) class I and II matched; DLA class I and II mismatched; and cyclosporin A (CsA) treated, DLA class I and II mismatched animals. Cyclosporin was given for 1 month, and all the animals were followed for 3 months after surgery. Mechanical properties were investigated using standard torsional tests, metabolic kinetics were assessed using isotopic prelabeling techniques, and histomorphometric analysis of cross-sectional area properties and sequential fluorochrome labels were performed. Autografts were mechanically stronger and stiffer than all the types of allograft. CsA-treated, DLA-mismatched allografts performed better than matched allografts. These in turn were stronger than non-CsA-treated, mismatched allografts, which underwent nearly complete resorption. These relationships were preserved in the metabolic and histologic analyses. In this short-term animal study, although DLA matching resulted in a slight improvement in graft outcome, mismatched grafts in dogs receiving a short course of cyclosporin A fared even better.

Bone metastasis from gynecologic carcinomas: a clinicopathologic study.

Between 1948 and 1984, autopsies were performed on 305 patients with primary carcinomas of the cervix, endometrium, ovaries, fallopian tubes, vulva, and vagina. Skeletal metastases were detected premortem and at autopsy in 49 cases (16.1%): cervix, 20 (40.8%); endometrium, 17 (34.7%); ovary, 7 (14.3%); vulva, 4 (8.2%); fallopian tube, 1 (2%). There were no cases of osseous metastasis from vaginal carcinoma. The incidence and sites of metastasis from these gynecologic carcinomas were correlated with their clinical and histopathologic classifications. This clinicopathologic study, based on autopsy data, demonstrates that osseous metastases are not uncommon, are significantly greater than clinically appreciated, and correlate with advanced anatomic stage and histopathologic type and grade.

Biological and physical properties of autogenous vascularized fibular grafts in dogs.

The biological and biomechanical properties of normal fibulae, fibulae that had had a sham operation, and both vascularized and non-vascularized autogenous grafts were studied in dogs at three months after the operation. The study was designed to quantify and correlate changes in these properties in orthotopic, stably fixed, weight-bearing grafts and to provide a baseline for additional studies of allografts. The grafts were eight centimeters long and internally fixed. The mechanical properties of the grafts were studied by torsional testing. Metabolic turnover of the grafts was evaluated by preoperative labeling of the dogs with 3H-tetracycline for resorption of bone mineral and with 3H-proline for turnover of collagen. Cortical bone area and porosity were measured. Postoperative formation of bone was evaluated by sequential labeling with fluorochrome. The vascularized grafts resembled the fibulae that had had a sham operation and those that had not had an operation with regard to the total number of osteons and the remodeling process, as measured both morphometrically and metabolically. The vascularized grafts were stronger and stiffer than the non-vascularized grafts and were not different from the bones that had had a sham operation. In contrast, the non-vascularized grafts were smaller, weaker, less stiff, and more porotic, had fewer osteons, and demonstrated increased turnover and resorption compared with the vascularized grafts, the bones that had had a sham operation, and the bones that had not been operated on.

Biology of cancellous bone grafts.

Despite 30 years of experimental bone grafting research, the fresh cancellous bone graft remains the most osteogenic and reliable bone grafting material. Recent experimental data suggest that modification of the graft-host interaction by antigen matching or immune manipulation may allow increasingly successful use of allografts.

The long-term fate of fresh and frozen orthotopic bone allografts in genetically defined rats.

Fresh and frozen orthotopic iliac crest bone grafts in rats were studied histologically for determination of the long-term effects of histocompatibility matching and the freezing process on orthotopic bone graft incorporation. Grafts exchanged between groups of inbred rats, syngeneic or differing with respect to major or minor histocompatibility loci, were studied histologically at 20, 30, 40, 50, and 150 days after bone transplantation. A numerical histologic scoring system was developed and used by three observers for evaluation of coded hematoxylin and eosin sections. All frozen graft groups had the same fate regardless of histocompatibility relations between donors and recipients, and all grafts were inferior to fresh syngeneic grafts. Both fresh allograft groups received similar scores and initially at 20 and 30 days had scores similar to those of the fresh syngeneic groups. In the later intervals, however, the fresh allografts were inferior to the fresh syngeneic grafts and similar to the frozen groups. This is consistent with an older model describing two distinct phases of osteogenesis. In the long term, frozen syngeneic and fresh and frozen allografts across major and minor histocompatibility barriers were comparable, but all were significantly inferior to fresh syngeneic bone grafts.

Effects on bone of vascular interruption. Turnover and morphology in isotope-prelabelled rats.

The effects of bone devascularization were evaluated histologically and metabolically in rats prelabelled with 45Ca, 3H-tetracycline and 3H-proline by quantifying cortical bone resorption and formation. The interruption of blood supply to bone without invading its integrity resulted in a marked increase in bone turnover (resorption and formation) during the first and second months. The stimulated increase in bone resorption and formation did not affect the resultant mass of collagen and calcium. Thus, the increase in bone resorption was compensated by an equivalent increase in bone formation.

Bone grafting: role of histocompatibility in transplantation.

The role of histocompatibility matching in bone allografting was studied in two canine bone graft models. In a cancellous ulnar segmental replacement model, frozen bone allografts exchanged between closely matched dogs were significantly better incorporated by radiographic and histologic criteria than were strongly incompatible grafts. Frozen allografts from disparate donors in recipients receiving immunosuppression appeared indistinguishable 6 months later from those in the untreated closely matched groups and from fresh autografts. Fresh vascularized orthotopically placed fibular bone grafts were evaluated by quantitative blood flow assessment, microangiography, and fluorochrome histomorphometry. Revascularized grafts exchanged between untreated closely matched dogs demonstrated preservation of blood flow and a pattern of repair that was delayed but not otherwise different than vascularized autografts. These results suggest that fresh vascularized grafts in the judiciously matched or immunosuppressed recipient offer attractive clinical possibilities.

Improved acceptance of frozen bone allografts in genetically mismatched dogs by immunosuppression.

UNLABELLED: We studied the role of immunosuppressive therapy in improving the incorporation of frozen bone allografts exchanged across strong transplantation barriers in a canine cancellous ulnar segmental replacement model. Dogs receiving frozen bone from donors with major histocompatibility differences received one of three different immunosuppressive treatments. In two groups, azathioprine and prednisolone were administered for either twenty-eight or fifty-six days; anti-lymphocyte globulin was added for another twenty-eight-day group in a third regimen. Frozen bone was evaluated radiographically and histologically by criteria that quantified the biological characteristics of the bone itself and union between the graft and host at thirteen and twenty-six weeks after grafting. Graft incorporation in these animals was compared with graft acceptance in a similar group of untreated animals and in untreated animals in which bone was exchanged across weak transplantation barriers. Complications of immunosuppression included wound drainage, infection, weight loss, and falling white-blood-cell counts. Seven of the original thirty-seven animals died as a direct result of these complications. After twenty-six weeks the grafts in the recipients receiving immunosuppression appeared radiographically and histologically indistinguishable from those in the untreated, genetically closely matched group and from autografts. They were significantly better incorporated than identical allografts placed in untreated, genetically disparate recipients. There was no difference in the effectiveness of any of the immunosuppressive programs. CLINICAL RELEVANCE: Immunosuppression improves the biological outcome of otherwise poorly performing frozen bone allografts in dogs. This finding suggests that treatments that modify the immunological response of the host without major side effects may be useful clinically in improving the success of massive frozen bone allografts.

Direct measurements of basal bone resorption in microphthalmic mice in vivo.

Microphthalmic mice and their normal littermates were prelabeled extensively in utero with 3H-tetracycline and 3H-proline, or with 45Ca alone. The loss of 3H-tetracycline and 3H-collagen from whole femur was measured from birth to 24 days of age at weekly intervals to determine bone resorption of mineral and matrix in vivo. The ratio of blood 45Ca specific activity to that of bone (blood/bone ratio) was used to reflect the interrelationship between bone, blood, and dietary calcium, as well as bone resorption. There was little, if any, loss of 3H-tetracycline and 3H-collagen from bones of the microphthalmic mutants whereas there was a marked and continuous loss (67 and 51%, respectively) from bones of the normal littermates due to normal bone modeling. Blood/bone ratio was much lower in the mutants (42-70%) compared with the normals, suggesting that blood calcium is maintained by diet. These data provide direct evidence that basal bone resorption in growing microphthalmic mice was almost completely inhibited.

The effect of histocompatibility matching on canine frozen bone allografts.

The value of histocompatibility matching in frozen bone allografts was studied in a canine cancellous ulnar segmental-replacement model. Frozen bone that was exchanged across strong and weak transplantation barriers was evaluated histologically and radiographically at thirteen and twenty-six weeks after grafting. Histological grading criteria quantified the type of union at each end of the graft and the degree of remodeling of the marrow, spongiosa, and compacta. Radiographic grading criteria included the presence of union at each end of the graft and the degree of remodeling of the graft segment. In vitro studies for serum antibody and cell-mediated immunity were carried out by isotopic cytotoxicity methods at seven intervals during the twenty-six-week study period. Histologically, the strong-barrier allografts had fewer osseous unions and less reorganization of spongiosa and marrow when compared with autograft controls at both thirteen and twenty-six weeks. Radiographically, the strong-barrier allografts at thirteen weeks had fewer unions and marked resorption of grafts material when compared with autograft controls. There were no differences between weak transplantation-barrier grafts and control autografts radiographically or histologically at thirteen and twenty-six weeks after grafting. Frozen bone allografts did not elicit detectable serum antibody or lymphocytes that were cytotoxic for donor cells.

The material properties of immature bone.

The age-related material properties of developing immature canine bone were determined for the femora, tibiae, humeri, radii, and ulnae in animals from 1 wk of age to maturity. These properties included bone geometry changes, material tissue properties, and qualitative and quantitative morphological evaluations. All bones exhibited a two-phase growth cycle, an initial rapid phase (20 wk) followed by a substantially slower growth to maturation (48 wk). All properties showed age-related changes except bone tissue strain to failure.

The role of osmic acid in the treatment of immune synovitis.

Thirty-seven New Zealand rabbits were observed for up to 1 year after their knee joints were instilled with 1 ml of 1% osmic acid. A selective destruction of synovial lining cells occurred with a concurrent synovitis, but lining cell regenerated by the eighth week. Nonprogressive abnormalities were also present in the cartilage. When an immune synovitis was induced in both knees of 16 rabbits, the osmic acid treated joint demonstrated a significantly greater synovitis and progressive aberrations compared to the untreated knee.

Comparison of whole calvarial bones and long bones during early growth in rats. II. Turnover of calcified and uncalcified collagen masses.

The increase of total collagen and its destruction were compared for whole calvaria and long bones from young growing rats prelabeled in utero with 3H-L-proline. Rats were compared from birth to 16 weeks of age. Long bones and calvaria were isolated as intact anatomical units for autoradiography or separated by collagenase into calified and uncalcified collagens. Autoradiography using 14C-L-proline demonstrated eccentric modeling of bone collagen. With growth the mass of calcified collagen (bone) increased rapidly in calvaria and long bones. A similar increase in the mass of uncalcified collagen (mainly cartilage) occured in the long bones; a very small increase occurred in the fibrous tissue of calvaria. Total and specific radioactivities of collagens at each age were compared to that present at birth. With growth remodeling an almost complete loss of pre-existing radioactive collagen occurred from uncalcified fibrous tissue of calvaria as compared to a smaller but substantial loss from the uncalcified cartilage of long bones. A marked loss of calcifed collagen occurred in long bones as compared to a smaller loss from calvarial bones. The istopic data indicate a large turnover of fibrous tissue (type I collagen) with growth remodeling as compared to a smaller turnover of bone (calcified, type I collagen) and cartilage (typc I collagen). The turnover rate of skeletal collagens depends upon whether the collagen is calcified or not, and not upon the type of collagen.

Contribution of collagen and mineral to the elastic-plastic properties of bone.

Tension testing of wet bovine haversian cortical bone demonstrated marked plastic behavior. Progressive surface decalcification of this bone with dilute hydrochloric acid resulted in progressive decreases in the tension yield point and the ultimate stress with no change in the yield strain or ultimate strain unless decalcification was complete. The slope of the plastic region remained identical throughout decalcification. These findings are consistent with an elastic-perfectly plastic model for the mineral phase of bone tissue in which the mineral contributes the major portion of the tension yield strength. The slope or stiffness of the plastic region of the stress-strain curve is a function only of the properties of collagen, which itself plays a minor role in the tension yield strength of bone.