Worse Recovery Research Articles

Sleep duration and lymphocyte subsets profile in European adolescents. The HELENA Study

Insufficient sleep is associated with higher incidence of infections and worse recovery, and more recently with increased risk for noninfectious diseases and low-grade inflammation (1) . The immune system seems to be strongly influenced by the sleep/wake cycle and has its own circadian rhythm, in both its functions and circulating cell numbers (2) . During adolescence sleep patterns experience significant changes, such as delay of sleep initiation and/or reduction of the sleep duration; therefore, sleeping habits at this period may have an impact on the immune system. In the present work, absolute and relative counts of leukocyte types and lymphocyte subsets were compared between adolescents reporting to sleep less than 8 hours per night (short-sleep group) and those reporting 8 hours or more (sufficient sleep). Blood samples were collected after an overnight fast from 1,089 boys and girls (12.5‐17.5 years old; 53.3% females) participating in the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross-Sectional Study). Leukocyte and lymphocyte subset counts were compared by means of analysis of covariance (ANCOVA), adjusting for country, gender, Tanner stage and body mass index (BMI). Non-normally distributed variables were previously log-transformed. Adolescents in the short-sleep group ( < 8h/night) presented higher counts and percentages of total T (CD3 + ; P < 0.05) and helper T (CD4 + ; P < 0.01) lymphocytes, higher counts of total memory T cells (CD3 + RO + ; P < 0.05) and memory helper T cells (CD4 + RO + ; P < 0.001), and lower percentages of natural killer cells (CD3 - CD16 + 56 + ; P < 0.05), independently of gender and BMI. Our results show a significant relationship between sleep duration and immune parameters in European adolescents, suggesting that sleep-related immune alterations can start at early life stages.

Spinal cord repair in MS

To investigate the mechanisms of spinal cord repair and their relative contribution to clinical recovery in patients with multiple sclerosis (MS) after a cervical cord relapse, using spinal cord (1)H-magnetic resonance spectroscopy (MRS) and volumetric imaging. Fourteen patients with MS and 13 controls underwent spinal cord imaging at baseline and at 1, 3, and 6 months. N-acetyl-aspartate (NAA) concentration, which reflects axonal count and metabolism in mitochondria, and the cord cross-sectional area, which indicates axonal count, were measured in the affected cervical region. Mixed effect linear regression models investigated the temporal evolution of these measures and their association with clinical changes. Ordinal logistic regressions identified predictors of recovery. Patients who recovered showed a sustained increase in NAA after 1 month. In the whole patient group, a greater increase of NAA after 1 month was associated with greater recovery. Patients showed a significant decline in cord area during follow-up, which did not correlate with clinical changes. A worse recovery was predicted by a longer disease duration at study entry. The partial recovery of N-acetyl-aspartate levels after the acute event, which is concurrent with a decline in cord cross-sectional area, may be driven by increased axonal mitochondrial metabolism. This possible repair mechanism is associated with clinical recovery, and is less efficient in patients with longer disease duration. These insights into the mechanisms of spinal cord repair highlight the need to extend spinal cord magnetic resonance spectroscopy to other spinal cord disorders, and explore therapies that enhance recovery by modulating mitochondrial activity.

Stroke in Women: Disparities and Outcomes

Stroke is the leading cause of disability in the United States and affects 15 million people worldwide. Studies performed in various parts of the world have found differences between sexes in stroke incidence, prevalence, mortality, and outcomes. Although men are at higher risk of stroke for most age groups below age 85 years, after this age the incidence reverses dramatically, with women being much more at risk. Furthermore, recent studies suggest that women have worse recovery than men post-stroke. Many aspects of recovery may influence this outcome, including sex-specific comorbidities, aggressiveness of acute treatment, prevention therapies, and varying degrees of social support and rates of depression. It is important to further define and investigate sex differences in stroke incidence, care, treatment, and outcomes to improve functional recovery in women.

Periodontal Ligament Remodeling and Alveolar Bone Resorption During Orthodontic Tooth Movement in Rats with Diabetes

Pathological displacement of teeth caused by periodontitis-related bone loss in patients with diabetes is often corrected with orthodontic treatments. However, recovery from orthodontic therapy is often delayed for unclear reasons. This study explored effects of streptozotocin-induced diabetes in rats on protein expression involved in remodeling of the periodontal ligament (PDL) and alveolar bone during orthodontic tooth movement. Forty-eight Sprague-Dawley rats were randomly divided into two experimental groups: "normal" and "diabetes" (n = 24 each). Diabetes was induced by a single dose of streptozotocin (65 mg/kg). Animals were euthanized at 3, 7, and 14 days after orthodontic induction. Changes in expression of collagen type I (Col-I), matrix metalloproteinase type 1 (MMP-1), and tissue inhibitor of MMP-1 (TIMP-1) were measured immunohistochemically in the pressure side. Col-I and collagen type III (Col-III) fibers were assessed by picrosirius red staining in the tension side. Osteoclasts were observed on the surface of the alveolar bone. Diabetes increased expression of MMP-1 and Col-III and decreased expression of Col-I in PDL. After the orthodontic induction, osteoclast action was delayed, and higher Col-III/Col-I and MMP-1/TIMP-1 ratios persisted in the diabetes group compared with the normal group. The ratio of MMP-1/TIMP-1 in the diabetes group reached a peak on Day 7, whereas the ratio remained at near control levels in the normal group. The diabetes group appeared to have worse recovery from damage caused by orthodontic movement. Under mechanical forces, diabetes prolonged duration of degradation of PDL and remodeling of PDL and resorption of alveolar bone.

262 Are Zucker Obese Rats a Useful Model for Cardiovascular Complications in Metabolic Syndrome? Physical, Biochemical and Oxidative Stress Considerations

We wondered if Zucker obese (ZO) rats would be a good experimental model to evaluate cardiovascular complications of Metabolic Syndrome (MS). ZO rats were compared with both their littermate controls, Zucker lean (ZL) rats and to Wistar rats (reference strain). We designed this work 1) to measure certain physical and biochemical characteristics of MS 2) to evaluate coronary and cardiac function in isolated conditions and after ischemia 3) to study plasma and heart tissue oxidative stress markers. In vivo, ZO rats had higher levels of plasma glucose, cholesterol and triglycerides than their ZL littermates, but there was no difference between the groups for systolic arterial blood pressure and heart rate. In vitro, coronary endothelial function was notably impaired in ZO and ZL rats. After global ischemia, the worse ventricular recovery in ZO and ZL rats was associated with arrhythmias during reperfusion. We detected similar levels of plasma ascorbyl free radical, Oxygen Radical Absorbance Capacity and vitamin C concentrations in the three groups. DHE staining showed higher superoxide production in the coronary vessels of ZO rats than in ZL and Wistar rats. Our results show that ZO might only correspond to early-stage cardiovascular complications associated with MS.

Evaluation of costs and outcome in cardioembolic stroke or TIA

The costs of acute stroke care, length of hospital stay (LOS), and outcome in patients with cardioembolic stroke or cardioembolic transient ischemic attacks (TIA) were investigated with the aim of estimating the clinical and health-economic impacts of cerebral cardioembolism. The study population consisted of 511 consecutive patients with the diagnosis of ischemic stroke (n = 379) or TIA (n = 132) treated at the Department of Neurology, Philipps University, Marburg. Cerebral cardioembolism was defined according to the criteria of the Cerebral Embolism Task Force. Clinical status was assessed by means of Barthel index (BI) and modified Rankin Scale. Costs were calculated using a bottom-up approach. All costs (in Euros) were inflated to the 2008 level. Compared to non-cardioembolic stroke (n = 278) patients, patients who had suffered cardioembolic stroke (n = 101) had more severe clinical deficits on admission (BI 46.3 +/- 27.0 vs. 59.3 +/- 34.1; P < 0.01), worse recovery (BI on discharge 59.2 +/- 28.9 vs. 73.1 +/- 33.4; P < 0.01), and increased LOS (12.6 +/- 5.7 vs. 10.0 +/- 7.8 days; P < 0.01). The latter also required a relatively higher daily resource utilization due to increased expenses for personnel and diagnostics. Mean costs of acute care for patients with cardioembolic stroke [euro 4890 per patient (95% confidence interval 4460-5200)] were significantly higher than those for patients with non-cardioembolic stroke [euro 3550 (95% confidence interval 3250-3850); P < 0.01]. The clinical and health-economic impact of cardiogenic cerebral embolism on stroke care is considerable. Patients with cardioembolic stroke/TIA are more severely impaired, and they require longer hospital treatment and increased resource utilization. Costs of acute care of cardioembolic stroke/TIA patients may exceed those of non-cardioembolic stroke/TIA by up to 40%.

Abstract 3595: Chloride Intracellular Channel-4 Determines Native Collateral Density

The density of native (pre-existing) collaterals in healthy tissue and their capacity to enlarge in occlusive disease (arteriogenesis) are major determinants of tissue injury in ischemia. Mechanisms regulating arteriogenesis remain unclear. Moreover, nothing is known about what specifies formation of native collaterals, except our report that VEGF contributes to native collateral formation (Clayton et al FASEB J 21:LB352, 2007). Recently, chloride intracellular channel proteins (CLICs) have been implicated in cellular processes including cell hollowing. CLIC1 and CLIC4 are expressed by endothelial cells, and VEGF-induced cell hollowing is critical for vascular formation in the embryo and angiogenesis in ischemia. Therefore, we examined CLIC1−/− and CLIC4−/− (null) mice for effects on native collateral density in healthy tissues and on arteriogenesis and angiogenesis in a hindlimb model of ischemia. Responses of CLIC1−/−mice did not differ from wild-type in any experiment. In contrast, CLIC4−/− showed a greater reduction in perfusion immediately after femoral ligation (p&lt;0.05 here and all statements below). Since baseline capillary density and collateral diameter were not different from wild-type, this suggested CLIC4−/− have reduced native collateral density. This was confirmed angiographically. In agreement, during 10 days after ligation CLIC4−/− mice had worse recovery of perfusion, greater ischemia and atrophy, and more impaired limb use, whereas collateral remodeling was unaffected. While ischemia increased expression of CLIC1 and CLIC4 similarly in wild-type mice, CLIC1 was augmented 3-fold in CLIC4−/−, suggesting CLIC1 may compensate for absence of CLIC4. Despite greater ischemia in CLIC4−/− mice, HIF1α and VEGF increased less in CLIC4−/−, suggesting CLIC4 may reside upstream of Hif1α-VEGF signaling. Native collateral density in the cerebral circulation of CLIC4−/− mice (but not CLIC1−/−) was also greatly reduced, resulting in 4-fold larger infarctions. This reduced collateral density in adults was associated with reduced formation and stabilization of nascent collaterals in the newborn. Hence, CLIC4 represents the second gene identified, besides VEGF, that specifies formation of the native collateral circulation.

Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction

The prevalence and consequences of financial barriers to health care services and medications are not well documented for patients with an acute myocardial infarction (AMI). To measure the baseline prevalence of self-reported financial barriers to health care services or medication (as defined by avoidance due to cost) among individuals following AMI and their association with subsequent health care outcomes. The Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, multicenter US study of patients with AMI over 12 months in 2498 individuals enrolled from January 2003 through June 2004. Health status symptoms (Seattle Angina Questionnaire [SAQ]), overall health status function (Short Form-12), and rehospitalization. The prevalence of self-reported financial barriers to health care services or medication was 18.1% and 12.9%, respectively. Among individuals who reported financial barriers to health care services or medication, 68.9% and 68.5%, respectively, were insured. At 1-year follow-up, individuals with financial barriers to health care services were more likely to have lower SAQ quality-of-life score (77.9 vs 86.2; adjusted mean difference= -4.0; 95% confidence interval [CI], -6.3 to -1.8), and increased rates of all-cause rehospitalization (49.3% vs 38.1%; adjusted hazard ratio [HR], 1.3; 95% CI, 1.1-1.5) and cardiac rehospitalization (25.7% vs 17.7%; adjusted HR, 1.3; 95% CI, 1.0-1.6). At 1-year follow-up, individuals with financial barriers to medication were more likely to have angina (34.9% vs 17.9%; adjusted odds ratio, 1.55; 95% CI, 1.1-2.2), lower SAQ quality-of-life score (74.0 vs 86.1; adjusted mean difference = -7.6; 95% CI, -10.2 to -4.9), and increased rates of all-cause rehospitalization (57.0% vs 37.8%; risk-adjusted HR, 1.5; 95% CI, 1.2-1.8) and cardiac rehospitalization (33.7% vs 17.3%; adjusted HR, 1.7; 95% CI, 1.3-2.2). Financial barriers to health care services and medications are associated with worse recovery after AMI, manifested as more angina, poorer quality of life, and higher risk of rehospitalization.

Relaxation of Alkali Glass Exposed to an Electron Beam

Binary potassium and rubidium silicate glasses were irradiated with high-energy electrons. The changes induced in the glasses were observed as a decay of alkali X-ray signals with time. The decay curves displayed incubation periods, connected with changes of the transport mechanism. The electron exposures were interrupted relative to the incubation periods, next the glasses were annealed to enable easier relaxations, and successively irradiated again to finish the decay curve. Relaxation, which depends on the point of the decay curve at which exposure is interrupted, is calculated for the glasses. Relaxation was found to depend strongly on the interruption point with regard to the incubation period. The longer irradiation causes worse recovery of the structure during annealing, especially if the irradiation lasts longer than the incubation time. The larger ions and lower concentration also inhibit relaxation.

Computed tomography to evaluate postoperative changes in free functioning muscle

Computed tomography (CT) was performed to evaluate the postoperative changes in free reinnervated muscles of 11 patients with soft tissue sarcomas. The muscle exhibited isodensity in six patients and low density in three. These nine patients had satisfactory recovery of the muscle without any clinical difference between the two groups. The remaining two muscles, which had unsatisfactory recovery, exhibited a mixture of very low and low density. The existence of a very low density area was thus related to worse recovery of function. Six of 11 patients underwent multiple CT at various stages after surgery. The cross-sectional area of the muscle changed significantly over time, and in five of the six transplants temporary shrinkage was observed for up to 1 year before muscle bulk increased. The muscle maintained its initial bulk at a mean follow-up of 111 months. These results indicate that CT can provide invaluable information on the structural changes in the free muscle.

The Effect of Poststroke Depression on Recovery from Stroke

Background: Stroke is a major health problem and poststroke depression is known to be one of the frequent and severe psychiatric complications following stroke. Methods: Based on the results of structured psychiatric mental state exams and DSM diagnostic criteria, the prevalence of poststroke depression has been examined in numerous study populations throughout the world. Longitudinal examinations have documented the effect of poststroke depression on recovery from stroke. Results: The mean prevalence of poststroke major depression was 21.1 % and minor depression was 17.1% among hospitalized or outpatient samples. Community samples showed a slightly lower rate of 14.1% and 9.1%, respectively. Furthermore, the existence of poststroke depression leads to poorer physical recovery, greater cognitive impairment, and worse recovery in activities of daily living compared with non‐depressed patients. Several studies have also found that poststroke depression is associated with increased mortality compared with non‐depressed patients who had comparable strokes and similar premorbid risk factors. Finally, several studies have found that successful treatment of poststroke depression improves both cognitive and physical recovery and decreases mortality. Conclusion: The current review documents the beneficial effect of identifying and treating poststroke depression on both recovery and survival following stroke.

Cortical mechanisms of recovery of function after stroke

Patients who have suffered hemiplegia from stroke may have some spontaneous recovery that is likely due to reorganization within the cerebral cortex. Understanding this physiology should be useful in devising ways to help patients have better improvement. Techniques, such as transcranial magnetic stimulation and neuroimaging with positron emission tomography, can be used to demonstrate the organization of the human motor system and do reveal plastic reorganization in a number of situations. In relation to stroke, the best recoveries are seen when there is preservation of the corticospinal tract from the hemisphere contralateral to the weakness, but it may well be that areas nearby to the normal motor output areas can partially substitute. There is some evidence for increased corticospinal tract activity originating ipsilateral to the hemiplegia in patients, but this may actually be associated with worse recovery. Patterns of use can influence cortical organization and should play a valuable role in rehabilitation. Certain drugs may affect this process either positively or negatively.

A double-blind trial of melatonin as a treatment for jet lag in international cabin crew

This study investigated the efficacy of oral melatonin in alleviating jet lag in flight crew after a series of international flights. The optimal time for taking melatonin in this group was also investigated. In a double-blind placebo-controlled trial, 52 international cabin crew were randomly assigned to three groups; early melatonin (5 mg started 3 days prior to arrival until 5 days after return home); late melatonin (placebo for 3 days then 5 mg melatonin for 5 days); and placebo. Daily ratings showed a trend in jet lag, mood, and sleepiness measures toward an improved recovery in the late melatonin group and a worse recovery in the early melatonin group as compared to placebo. Retrospective ratings made 6 days after arrival showed the late melatonin group reported significantly less jet lag and sleep disturbance following the flight compared to placebo. The late melatonin group also showed a significantly faster recovery of energy and alertness than the early melatonin group, which reported a worse overall recovery than placebo. These findings show melatonin may have potential benefits for international aircrew.