Postural Control in Individuals with Parkinson’s Disease

Parkinson’s disease is the second most common neurodegenerative disorder in the elderly population. It is a complex, progressive, multisystem disease associated with motor and nonmotor impairments. Postural instability is a crucial component of functional mobility, often overlooked by both clinicians and patients with Parkinson’s disease. It is a refractory drug complication for which rehabilitation is the most effective nonpharmacological aid. However, many interventions are based on empirical experience. Improving knowledge on the pathophysiology of postural control disorders is crucial to understand the multifaceted components affected and thus design specific rehabilitation protocols. This chapter intends to offer a comprehensive overview of the current knowledge on this topic starting from the pathophysiology of postural control disorders occurring in various ecological conditions to the most innovative multidisciplinary rehabilitation approaches

Online Math Tasks Generator

This article presents “Math for all” – a web application that generates various algebraic equations and inequalities. We discuss algorithms and methods that are implemented in building the library that generates all the expressions, and some problems that are solved in the process of our work

Online Math Tasks Generator

This article presents “Math for all” – a web application that generates various algebraic equations and inequalities. We discuss algorithms and methods that are implemented in building the library that generates all the expressions, and some problems that are solved in the process of our work

Embolization of bronchial arteries in cases of life-threatening bleeding

Massive hemoptysis is a frightening and potentially life-threatening clinical event. Hemoptysis represents a sig­nificant clinical entity with high morbidity and potential mortality. Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage

2-year single center clinical experience in patients with colon cancer stage II and III receiving adjuvant chemotherapy

Introduction: Colorectal cancer is the most commonly diagnosed gastrointestinal cancer worldwide. For patients without metastatic disease, surgery is the first option used with curative intention, for stage I disease the adequate treatment consists only of surgical excision. In stage III additional adjuvant chemotherapy post-surgery is recommended. In stage II colon cancer, adjuvant treatment remains controversial.We aim to stratify patients according to different criteria, identify those with recurrence within the first year post last cycle of adjuvant chemotherapy and discuss those primary results.Materials and methods: a total of 52 patients who were subject to curative resection of stage II and III colon adenocarcinoma and who were administrated 5 FU based adjuvant chemotherapy were included and were followed for a period of two years. Data analysis was performed.Result: After a mean of 2 years of follow-up, recurrence was identified in 16 patients. None of stage II patients (n=6) and 3 patients in stage III (n=6) experienced recurrence. Patients with Nx cancer (n=30) were detached in separate group. Thirteen of them experienced recurrence (9 patients had relapse within 6 months after surgery - defined as synchronous metastatic disease).Conclusion: Surgery remains the cornerstone of treatment for the majority of colon patients. The selection of optimal chemotherapy for each patient is a complex process and there is a practice evidence gap which remains a significant problem. Our results for relapse are comparable with the reported ones worldwide. The reports suggest that there is still lack of evidence in the adjuvant colon cancer chemotherapy worldwide

Treatment of tetanus in childhood with MgSO4 - benefits and risks

Тетанус е остра инфекциозна болест, характеризираща се с клиничната триада мускулна ригидност, мускулен спазъм и дисфункция на автономната нервна система. Овладяването на болезнения, протрахиран мускулен спазъм и ригидност е основен момент в лечението. В кли-ничната практика са използвани редица медикаменти като бензодиазепини, опиати, пропофол, дантролен, баклофен, мускулни релаксанти. Алтернативно средство за контрол е MgSO4.Представяме клиничен случай на 12-год. Дете с тетанус, при който за първи път в нашето от-деление бе използвана продължителна интравенозна инфузия на MgSO4. Медикаментът бе при-ложен за контрол на мускулните спазми в комбинация с Dormicum, Tilidine и Baclofen. С добавянето към терапията на MgSO4 успяхме да овладеем мускулния спазъм и да намалим ригидността, избягвайки повишаване на дозите на седативи и опиати, както и провеждането на ендотрахеална интубация с последваща трахеостомия, изкуствена белодробна вентилация (ИБВ) и мускулна релаксация.Решението да представим нашия опит за управление на тетанус с прилагане на непрекъсната i.v. Инфузия с MgSO4 бе продиктувано от факта, че в литературата се откриха само единични клинични случаи. Посочените дози бяха твърде вариабилни, може би защото децата бяха с различна степен на тежест на заболяването, със или без подкрепяща ИБВ. Тези факти ни мотивираха да опишем подробно нашия клиничен случай с оглед подкрепа на бъдещата кли-нична практика у нас.Tetanus is an acute infectious disease characterized by clinical triad muscle rigidity, muscle spasm and dysfunction of the autonomic nervous system. The management of the painful, protracted muscle spasm and rigidity is a basic element in the treatment of tetanus. Numerous medications such as benzodiazepines, opiates, propofol, dantrolene, baclofen, muscle relaxants have been used in clinical practice. An alternative agent is MgSO4.We present a clinical case of tetanus in a 12-year-old child, in which a prolonged intravenous infusion of MgSO4 was used for the first time at our intensive care unit. The drug was used to control muscle spasms in combination with Dormicum, Tilidine and Baclofen. With the addition of MgSO4 to the therapy, we managed to control muscle spasms and to reduce rigidity, avoiding increase in the doses of the sedative and opiate, as well as endotracheal intubation followed by tracheostomy, mechanical ventilation and muscle relaxation.The decision to present our experience of managing tetanus by application of continuous i.v. infusion with MgSO4 was due to the fact that only single clinical cases were described in the literature. Furthermore, the indicated doses were too variable, perhaps because the children were with varying severity of tetanus, with or without supportive artificial lung ventilation. These facts motivated us to describe our clinical case in detail in order to support future local clinical practice

First line 5-FU-based chemotherapy with/without bevacizumab for metastatic colorectal cancer: one center experience results

Purpose: Colorectal cancer is the second leading cause of cancer mortality in the United States. According to the National Institute of Statistics in Bulgaria for 2012 there have been 2370 newly diagnosed colon cancer and 1664 rectal cancer cases and the total number of registered patients is 29995. Adding Bevacizumab to chemotherapy in patients with metastatic colorectal cancer improves progression-free survival but yet no predictive markers for patient selection have been described and proved in the clinical practice. In our study we examined two plasma biomarkers that may correlate with response to first line Bevacizumab containing chemotherapy in patients with metastatic colorectal cancer.Patients and Methods: 54 patients with metastatic colorectal cancer were assigned to first line 5-Fubased chemotherapy with/without Bevacizumab. The primary end point was progression-free survival, with additional determination of response and toxicity. Blood samples were collected at baseline from all 54 patients prior to initiation of chemotherapy and Bevacizumab. Plasma samples were stored at -80º C until analysis at the Immunology Laboratory at the University Hospital `St. Marina` (Varna, Bulgaria) by a multiple-step sandwich immunoassay Human ELISA VEGF121 and VEGF165 kits.Results: The median progression-free survival for the group treated with CT/Bev was 8.8 months, compared with 5.4 months for the group treated with chemotherapy alone (95% CI, log-rank test P =0.003). The corresponding overall response rates were 19.3% and 10.2% respectively (P < 0.05 for CT/Bev vs CT).Conclusion: The addition of Bevacizumab to 5-Fu based chemotherapy improves progression-free survival duration for patients with metastatic colorectal cancer. We could not find any association between pretreatment plasma levels of VEGF 121 and 165 and worse PFS

Robot-assisted stair climbing training on postural control and sensory integration processes in chronic post-stroke patients: a randomized controlled clinical trial

Background: Postural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities. Objective: The primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility. Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment. Results: There was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions. Conclusion: Postural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901)

Expression of hepatic HMGB1 levels in fructose-induced fatty liver

Проучването на процесите, водещи до хепатоцелуларна клетъчна смърт, е важно за клиничната практика за оценка на тежестта на чернодробното увреждане, както и прилагането на ефективни интервенции за предотвра-тяването й. Наблюденията показват, че и двата процеса - апоптоза и некроза, се активират в относителна степен на определени етапи от прогресията на неалкохолната мастна чернодробна болест - от чернодробна стеатоза, стеа-тохепатит и цироза. В момента най-обещаващият неинвазивен специфичен метод за установяване на некротична клетъчна смърт е нехистоновият ДНК-свързващ протеин с висока подвижност група Б1 (HMGB1). Целта на настоящото изследване бе да се проучат нивата на експресията на HMGB1 и връзката им с чернодробните увреждания и активността на апоптоза в черния дроб на плъхове с фруктозо-индуциран мастен черен дроб. Използвахме мъжки плъхове Wistar, разделени на две групи (n = 7): контролна (на стандартна храна) и експериментална, която приемаше разтвор с високо съдържание на фруктоза (ФРУ) (35% фруктозен царевичен сироп за 16 седмици). Метаболитните нарушения и увреждането на черния дроб са изследвани чрез хистохимични (Н&Е), имунохистохимични, имунологични биохимични тестове. Резултатите по-казаха данни за метаболитен синдром, дребнокапчеста стеатоза, статистически намалени нива на HMGB1, увеличено съотношение на апоптотичните протеини Bax/Bcl2 при плъховете на фруктозна диета.The study of the processes leading to hepatocellular cell death is important for clinical practice to assess the severity of hepatic impairment as well as for the application of effective interventions to prevent it. Observations show that both cell death processes - apoptosis and necrosis are activated at certain stages of the progression of non-alcoholic fatty liver disease from hepatic steatosis, steatohepatitis and cirrhosis. Currently, the most promising non-invasive specific method for detecting necrotic cell death is non-histone DNA-binding protein with high mobility Group B1 (HMGB1). The aim of this study was to investigate the levels of HMGB1 expression and their relationship to hepatic injury and apoptosis activity in rat liver with fructose-induced metabolic syndrome. The results showed data for metabolic syndrome, microvascular steatosis, statistically reduced levels of HMGB1, an increased ratio of Bax/Bcl2 apoptotic proteins in fructose fed rats