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.

Differences in the Prevalence of Sarcopenia in Community-Dwelling, Nursing Home and Hospitalized Individuals. A Systematic Review and Meta-Analysis.

BACKGROUND: Sarcopenia is an age-related disease which leads to a decline in muscle mass and function and is one of the most important health issues in elderly people with a high rate and variety of adverse outcomes. OBJECTIVE: The current systematic review and meta-analysis study was carried out to estimate the overall prevalence of sarcopenia in both males and females in different regions around the world and to show the major differences in its occurrence among different populations. DESIGN: A systematic review and meta-analysis of studies published in PubMed (Medline) and Scopus. PARTICIPANTS: Community dwelling, nursing home and hospitalized older adults aged over 60 years. MEASUREMENTS: Sarcopenia was defined by the major validated diagnostic criteria, such as the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia (AWGS) and the International Working Group on Sarcopenia (IWGS). The model used was the random effect model for estimating the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia as well as 95% CI (Confidence interval) were calculated using MetaXL (version 5.3). Heterogeneity assessment was carried out by subgroup analysis. RESULTS: We included 41 studies with a total of 34955 participants. The prevalence of sarcopenia in community-dwelling individuals in the included studies were 11% (95% CI: 8-13%) in men and 9% (95% CI: 7-11%) in women. The prevalence of sarcopenia in nursing-home individuals in the included studies were 51% (95% CI: 37-66%) in men and 31% (95% CI: 22-42%) in women and in hospitalized individuals were 23% (95%, CI: 15-30%) in men and 24% (95% CI: 14-35%) in women. CONCLUSIONS: Despite the differences encountered between the studies, regarding diagnostic tools used to measure of muscle mass, different regions around the world and different populations and clinical settings, this systematic review revealed that a significant proportion of old people has sarcopenia (major in nursing homes), even in populations healthy in general. However, sarcopenia is caused by the aging progress, early diagnosis and individualized care, including physical activity and nutrition, can prevent some adverse outcomes in all populations.

Food insecurity and Mediterranean diet adherence among Greek university students.

AIM: To assess Mediterranean diet (MD) adherence and food insecurity (FI) among university students in Greece. METHODS AND RESULTS: A non-probability sample of 236 students was recruited from Athens and Thessaloniki during 2016. FI was assessed with the Household Food Insecurity Access Scale and MD adherence with the MEDAS questionnaire. Mean MEDAS score of the sample was 6.4 ± 1.9, with women demonstrating greater MD adherence compared to men (p = 0.016) and Dietetics students exhibiting increased score compared to the rest (p ≤ 0.001). A low proportion of participants were food-secure (17.8%), 45.3% were severely food-insecure, 22.0% experienced moderate FI and the remaining 14.8% had low FI. Participants studying in the city they grew up exhibited lower FI compared to those studying in other cities (p = 0.009), while, additionally, a trend was noted for increased FI among students with an unemployed family member (p = 0.05). Students working night shifts had lower MD adherence and increased FI compared to the rest (p = 0.004 and p = 0.003, respectively). The same pattern was observed among participants who smoked (p = 0.003 for MD adherence and p = 0.009 for FI, respectively). Multivariate regression analyses did not reveal any connections between FI categories, waist circumference or BMI, but showed an inverse relationship between severe FI and MD adherence. CONCLUSIONS: The majority of the surveyed university students from Greece demonstrate some degree of FI, with a great proportion being severely food-insecure. Increased FI is inversely associated with MD adherence.

Nutrition strategies before and during ultra-endurance event: A significant gap between science and practice.

The purpose of this study was to investigate and assess the nutritional practices of open-water swimmers, during the preparation period and the competition, as well as their implications on performance and anthropometric parameters according to their age. Twenty-four (n = 24) men open-water swimmers, twelve young (26.3 ± 4.9 years) and twelve older athletes (45.8 ± 9.7 years), participated in this study. Nutritional behavior-energy intake consumption, and anthropometric characteristics were evaluated prior to the Toroneos Gulf crossing (26 km). In addition, nutritional intakes during the race and anthropometrics after the race were also evaluated. Significant differences between the two groups were found for Toroneos Gulf crossing performance, BMI, and all variables of body composition at the preparation period (P < .05). The results involving energy consumption, in both preparation period and during the race, displayed significant differences between the two groups, while both groups exhibited significantly negative energy balances. During the race, significant differences were found also for the energy expenditure, relative energy intake, negative energy balance, relative consumption of carbohydrates per hour, and relative protein intake (P < .05). In both groups, lower intakes than the recommended were observed for macronutrient-micronutrient elements at any time point. Significant correlations were found between selected variables of body composition, nutritional intakes during the preparation period and the competition, and athletes' performance. In summary, this study provides strong evidence about the malnutrition of ultra-endurance swimmers prior and during their competition, with potential dangers for their health and performance as certain deficiencies in both macro- and micronutrient contents are present.

Standardized evaluation framework for evaluating coronary artery stenosis detection, stenosis quantification and lumen segmentation algorithms in computed tomography angiography.

Though conventional coronary angiography (CCA) has been the standard of reference for diagnosing coronary artery disease in the past decades, computed tomography angiography (CTA) has rapidly emerged, and is nowadays widely used in clinical practice. Here, we introduce a standardized evaluation framework to reliably evaluate and compare the performance of the algorithms devised to detect and quantify the coronary artery stenoses, and to segment the coronary artery lumen in CTA data. The objective of this evaluation framework is to demonstrate the feasibility of dedicated algorithms to: (1) (semi-)automatically detect and quantify stenosis on CTA, in comparison with quantitative coronary angiography (QCA) and CTA consensus reading, and (2) (semi-)automatically segment the coronary lumen on CTA, in comparison with expert's manual annotation. A database consisting of 48 multicenter multivendor cardiac CTA datasets with corresponding reference standards are described and made available. The algorithms from 11 research groups were quantitatively evaluated and compared. The results show that (1) some of the current stenosis detection/quantification algorithms may be used for triage or as a second-reader in clinical practice, and that (2) automatic lumen segmentation is possible with a precision similar to that obtained by experts. The framework is open for new submissions through the website, at http://coronary.bigr.nl/stenoses/.

Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease?

Smoking, both active and passive, is an established vascular risk factor. The present narrative review considers the effects of different forms of smoking (i.e. cannabis, cigar, pipe, smokeless tobacco and cigarette) on cardiovascular risk. Furthermore, the impact of smoking on several vascular risk factors [e.g. hypertension, diabetes mellitus (DM), dyslipidaemia and haemostasis] and on vascular diseases such as coronary heart disease (CHD), peripheral arterial disease (PAD), abdominal aortic aneurysms (AAA) and carotid arterial disease, is discussed. The adverse effects of all forms of smoking and the interactions between smoking and established vascular risk factors highlight the importance of smoking cessation in high-risk patients in terms of both primary and secondary vascular disease prevention. Healthcare providers should discourage people (especially the young) from becoming smokers, strongly encourage all vascular patients to stop smoking and support those who decide to quit by pharmaceutical and psychological interventions. In high-risk populations such as patients with CHD, DM and/or PAD, smoking cessation should always be a part of a multifactorial treatment to reduce vascular risk.

PCT as a diagnostic and prognostic tool in burn patients. Whether time course has a role in monitoring sepsis treatment.

OBJECTIVE: To evaluate the diagnostic and prognostic performance of inflammatory markers for septic and non septic (localized) bacterial infections in patients with severe burn. METHODS AND RESULTS: Data of 145 patients were prospectively included in this study. Serum procalcitonin and other inflammatory markers were measured within 24 h after burn and daily thereafter. Maximum procalcitonin (p=0.004) was independent predictors of outcome in logistic regression analysis. PCT thresholds of 1.5 ng/ml, 0.52 ng/ml and 0.56 ng/ml had adequate sensitivity and specificity to diagnose sepsis, respiratory tract and wound infections respectively. A threshold value of 7.8 ng/ml in PCT concentration on day 3 was associated with the effectiveness of the sepsis treatment with an AUC of 0.86 (95% CI 0.69-1.03, p=0.002). C-reactive protein levels and WBCs showed no significant change over the first 3 days in the patients with successfully treated sepsis (p=0.93). CONCLUSION: The maximum procalcitonin level has prognostic value in burn patients. PCT can be used as a diagnostic tool in patients with infectious complications with or without bacteremia during ICU stay. Daily consecutive PCT measurements may be a valuable tool in monitoring the effectiveness of antibiotic therapy in burn ICU patients.

Evaluation of a multi-atlas based method for segmentation of cardiac CTA data: a large-scale, multicenter, and multivendor study.

PURPOSE: Computed tomography angiography (CTA) is increasingly used for the diagnosis of coronary artery disease (CAD). However, CTA is not commonly used for the assessment of ventricular and atrial function, although functional information extracted from CTA data is expected to improve the diagnostic value of the examination. In clinical practice, the extraction of ventricular and atrial functional information, such as stroke volume and ejection fraction, requires accurate delineation of cardiac chambers. In this paper, we investigated the accuracy and robustness of cardiac chamber delineation using a multiatlas based segmentation method on multicenter and multivendor CTA data. METHODS: A fully automatic multiatlas based method for segmenting the whole heart (i.e., the outer surface of the pericardium) and cardiac chambers from CTA data is presented and evaluated. In the segmentation approach, eight atlas images are registered to a new patient's CTA scan. The eight corresponding manually labeled images are then propagated and combined using a per voxel majority voting procedure, to obtain a cardiac segmentation. RESULTS: The method was evaluated on a multicenter/multivendor database, consisting of (1) a set of 1380 Siemens scans from 795 patients and (2) a set of 60 multivendor scans (Siemens, Philips, and GE) from different patients, acquired in six different institutions worldwide. A leave-one-out 3D quantitative validation was carried out on the eight atlas images; we obtained a mean surface-to-surface error of 0.94 +/- 1.12 mm and an average Dice coefficient of 0.93 was achieved. A 2D quantitative evaluation was performed on the 60 multivendor data sets. Here, we observed a mean surface-to-surface error of 1.26 +/- 1.25 mm and an average Dice coefficient of 0.91 was achieved. In addition to this quantitative evaluation, a large-scale 2D and 3D qualitative evaluation was performed on 1380 and 140 images, respectively. Experts evaluated that 49% of the 1380 images were very accurately segmented (below 1 mm error) and that 29% were accurately segmented (error between 1 and 3 mm), which demonstrates the robustness of the presented method. CONCLUSIONS: A fully automatic method for whole heart and cardiac chamber segmentation was presented and evaluated using multicenter/multivendor CTA data. The accuracy and robustness of the method were demonstrated by successfully applying the method to 1420 multicenter/ multivendor data sets.

Use of intraluminal stapler device for creation of a permanent colostomy.

We present our experience with the use of the intraluminal stapler device for the purpose of creating of a dermal permanent colostomy, in cases of acute emergency operations and of regular programmed operations. The advantages of this method for those surgeons who use stapling devices are: controlled safety of the colostomy, shorter operation time and the creation of a stable diameter of the colostomy. All patients of this category as well as those having been operated on for colon cancer have been placed on a protocol follow up for three years and are closely monitored. This has allowed us to closely follow these patients in cases of complications.

Significance of urokinase-type plasminogen activator and plasminogen activator inhibitor-1 (PAI-1) expression in human colorectal carcinomas.

Despite the advances in the medical care of colorectal carcinoma patients, the prognosis has improved only marginally over recent decades. Thus, additional prognostic indicators would be of great clinical value to select patients for adjuvant therapy. In the present study, the antigen levels of urokinase-type plasminogen activator (uPA) and its inhibitor PAI-1, and their immunohistochemical staining were compared in paired colorectal tumor (n = 64) and background colon tissue of the same patients with clinical and pathological staging. The antigen levels, measured with an ELISA method, were found to be significantly higher in cancer tissue (mean 1.92 ng/mg protein for uPA and 7.08 for PAI-1) than in corresponding normal mucosa (0.29 ng/mg protein for uPA and 1.11 ng/mg protein for PAI-1). There was a positive correlation between uPA and PAI-1 antigen levels and clinicopathological parameters such as grade (p < 0.001 and p = 0.01, respectively), while for Dukes' stage, only PAI-1 correlated positively (p = 0.018). Nodal status correlated positively with uPA but not with PAI-1 antigen levels. Immunohistochemical localization of both antigens was observed mainly in cancer cells and much less in stromal cells. Staining intensity increased from adenoma to adenocarcinoma. The degree of staining was associated with grade, Dukes' stage and nodal status for uPA (p < 0.001, p = 0.002, p < 0.001, respectively) and only with grade for PAI-1 (p = 0.007).

Expression of gelatinase-A (MMP-2) in human colon cancer and normal colon mucosa.

Proteolytic enzymes, such as type IV collagenases (MMP-2 gelatinase A, 72-kD type IV collagenase and MMP-9 gelatinase B, 92-kD type IV collagenase) play an important role in tumor invasion and metastasis. In the present study the levels of MMP-2 antigenic concentration and immunohistochemical staining were compared in paired colorectal tumor (n = 64) and background colon tissue of the same patients with clinical and pathological staging. The antigenic concentrations were found to be statistically significantly higher in cancer tissue (mean 11.29 ng/mg protein) than in corresponding normal mucosa (10.23 ng/mg protein) (p = 0.008). There was also a positive correlation between MMP-2 antigenic concentration and clinicopathologic parameters such as grade (p < 0.001) and Dukes' stage (p = 0.001), but not with lymph node involvement. Immunohistological localization of MMP-2 was observed in tumor as well as in stromal cells. Staining intensity increased from adenoma to adenocarcinoma. The degree of staining was associated with grade (p < 0.001), Dukes' stage (p < 0.001) and lymph node involvement (p < 0.001).

The Aspergillus niger acuA and acuB genes correspond to the facA and facB genes in Aspergillus nidulans.

Mutants in Aspergillus niger unable to grow on acetate as a sole carbon source were previously isolated by resistance to 1.2% propionate medium containing 0.1% glucose. AcuA mutants lacked acetyl-CoA synthetase (ACS) activity and acuB mutants lacked both ACS and isocitrate lyase activity. An acuA mutant was transformed to the acu+ phenotype with a clone of ACS (facA) from Aspergillus nidulans. The acuB mutant was transformed with the A. niger facB clone which has been identified by cross-hybridisation of an A. nidulans facB clone. These results confirm that acuA in A. niger is the gene for ACS and acuB is analogous to the A. nidulans facB regulatory gene.

The prognostic value of alpha-thymosins in breast cancer.

The prognosis of breast cancer is of major clinical importance and several histopathological, biochemical and immunological variables have been reported to be useful prognostic factors. In the present study, we investigated the clinical significance of the levels of alpha-thymosins in relation to established prognostic factors, both in breast cancer and non-malignant breast lesions, alpha-thymosin levels were measured in breast tissue extracts by specific radioimmunoassays (RIAs) developed for human prothymosin alpha (ProT alpha) and parathymosin alpha (ParaT alpha) and were found to be significantly higher (up to 17.2-fold) in malignant but not in benign breast lesions, as compared to the values of the neighbouring tissues. When alpha-thymosin levels of the tumor samples were correlated with various known prognostic parameters a statistically significant correlation (p < 0.05) was observed between the levels of ProT alpha in malignant tissues to the grade of cancer and the lymph node status of the patient. An association between ProT alpha levels with increase in risk of death from breast cancer was also noticed. These results suggest that the expression of alpha-thymosins in human breast cancer a) depends on the proliferation status of the tumor, b) associates with established prognostic factors describing the metastatic potential of the tumor and c) is related to the overall survival of the patient. The fact that such relationships hold only for cancer tissues encourages the future use of alpha-thymosins as potent prognostic factors in breast cancer.