Krónikus alimentáris urticaria kezelése Zaditennel

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The effects of functional balance training on balance, functional mobility, muscle strength, aerobic endurance and quality of life among community-living elderly people

Aim. The aim of this study was to investigate the effects of functional training on balance, functional mobility, muscle strength, aerobic endurance and quality of life among community-dwelling elderly people. Material and methods. Eighteen women were in the exercise group taking part in functional training program for 25 weeks; the control group did not participate in any exercise program. The Fullerton test for balance, Timed Up and Go test for functional mobility, Five-Times-Sit-to-Stand Test for lower limb strength, Two-Minute-Step-in-Place Test for endurance and the quality of life were measured at baseline and after 25 weeks. Results. After the training period in the exercise group the balance and the functional mobility improved more significantly than in the control group (p = 0.027; p = 0.0004, respectively). The quality of life showed a marginal significance (p = 0.083). In terms of lower limb muscle strength and aerobic endurance, the difference between the groups did not reach statistical significance (p = 0.276; p = 0.147). Conclusion. This 25-week functional training improves balance, functional mobility, as well as quality of life among community-living elderly adults; however functional training exercises might require to be completed with more tailored strength exercises. Clinical Rehabilitation Impact. Based on our results, functional training might be a promising exercise program for improving balance, functional mobility and quality of life for community-living elderly people

External beam accelerated partial breast irradiation: dosimetric assessment of conformal and three different intensity modulated techniques

Background The aim of the study was to evaluate and compare four different external beam radiotherapy techniques of accelerated partial breast irradiation (APBI) considering target coverage, dose to organs at risk and overall plan quality. The investigated techniques were three dimensional conformal radiotherapy (3D-CRT), "step and shoot" (SS) and "sliding window" (SW) intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (RA). Patients and methods CT scans of 40 APBI patients were selected for the study. The planning objectives were set up according to the international recommendations. Homogeneity, conformity and plan quality indices were calculated from volumetric and dosimetric parameters of target volumes and organs at risk. The total monitor units and feasibility were also investigated. Results There were no significant differences in the coverage of the target volume between the techniques. The homogeneity indices of 3D-CRT, SS, SW and RA plans were 0.068, 0.074, 0.058 and 0.081, respectively. The conformation numbers were 0.60, 0.80, 0.82 and 0.89, respectively. The V50% values of the ipsilateral breast for 3D-CRT, SS, SW and RA were 47.5%, 40.2%, 39.9% and 31.6%, respectively. The average V10% and V40% values of ipsilateral lung were 13.1%, 28.1%, 28%, 36% and 2.6%, 1.9%, 1.9%, 3%, respectively. The 3D-CRT technique provided the best heart protection, especially in the low dose region. All contralateral organs received low doses. The SW technique achieved the best plan quality index (PQI). Conclusions Good target volume coverage and tolerable dose to the organs at risk are achievable with all four techniques. Taking into account all aspects, we recommend the SW IMRT technique for APBI

A nyaki ütőerek dissectiója – 19 eset retrospektív elemzése

Absztrakt: A cervicalis agyi erek dissectiója az ischaemiás stroke-betegség gyakori oka a fiatal felnőttek körében. Kialakulhat erőteljes nyaki trauma, de minor erőbehatás következtében is. Gyakori a spontán esetek előfordulása, melyek genetikai, anatómiai és környezeti tényezőkkel is összefüggésbe hozhatók. A kórkép klinikai megjelenése változatos, a tünetek lehetnek kizárólag helyi jellegűek, illetve az érintett arteriás területre jellemzőek. Korai felismerése kiemelkedően fontos, ugyanis az idejében megkezdett kezeléssel kimenetele számottevően javítható. A végleges diagnózis felállításához a képalkotó eljárások elengedhetetlenek. A közlemény célja a cervicalis agyi erek dissectiójának (carotis és vertebralis arteria dissectio) összefogló leírása 19 eset bemutatása kapcsán. A vizsgálat során három év alatt a Neurológiai Klinikán extracranialis arteria dissectio miatt kezelt betegek klinikai jellemzőit, rizikófaktorait, diagnosztikai eredményeit és terápiáját elemeztük. A kórkép prognózisa változatos, betegeink 42%-a tünetmentessé vált. Orv Hetil. 2019; 160(22): 861–868. | Abstract: Cervical artery dissection is a common cause of stroke in young adults. It might occur shortly after a forceful neck trauma or a minor injury. However, spontaneous dissection is also common, which is associated with genetic, anatomical or environmental risk factors. Cervical artery dissection can produce a broad spectrum of clinical presentation varying from local symptoms to focal neurological deficits determined by the arterial territory involved. Early recognition is important since immediate initiation of treatment can significantly improve patient outcomes. While clinical features may raise suspicion for dissection, the diagnosis has to be confirmed by neuroimaging findings. The purpose of this paper is to give an overview on cervical (carotid and vertebral) artery dissections while presenting 19 cases. During three years, we evaluated the clinical features, risk factors, diagnostic and therapeutic procedures of these patients admitted with extracranial artery dissection. The prognosis of the disease can vary, 42% of our patients became asymptomatic. Orv Hetil. 2019; 160(22): 861–868

Inflammasome activation in peritumoral astrocytes is a key player in breast cancer brain metastasis development

Inflammasomes, primarily responsible for the activation of IL-1β, have emerged as critical regulators of the tumor microenvironment. By using in vivo and in vitro brain metastasis models, as well as human samples to study the role of the NLRP3 inflammasome in triple-negative breast cancer (TNBC) brain metastases, we found NLRP3 inflammasome components and IL-1β to be highly and specifically expressed in peritumoral astrocytes. Soluble factors from TNBC cells induced upregulation and activation of NLRP3 and IL-1β in astrocytes, while astrocyte-derived mediators augmented the proliferation of metastatic cells. In addition, inhibition of NLRP3 inflammasome activity using MCC950 or dampening the downstream effect of IL-1β prevented the proliferation increase in cancer cells. In vivo, MCC950 reduced IL-1β expression in peritumoral astrocytes, as well as the levels of inflammasome components and active IL-1β. Most importantly, significantly retarded growth of brain metastatic tumors was observed in mice treated with MCC950. Overall, astrocytes contribute to TNBC progression in the brain through activation of the NLRP3 inflammasome and consequent IL-1β release. We conclude that pharmacological targeting of inflammasomes may become a novel strategy in controlling brain metastatic diseases

Cerebral pericytes and endothelial cells communicate through inflammasome-dependent signals

By upregulation of cell adhesion molecules and secretion of proinflammatory cytokines, cells of the neurovascular unit, including pericytes and endothelial cells, actively participate in neuroinflammatory reactions. As previously shown, both cell types can activate inflammasomes, cerebral endothelial cells (CECs) through the canonical pathway, while pericytes only through the noncanonical pathway. Using complex in vitro models, we demonstrate here that the noncanonical inflammasome pathway can be induced in CECs as well, leading to a further increase in the secretion of active interleukin-1β over that observed in response to activation of the canonical pathway. In parallel, a more pronounced disruption of tight junctions takes place. We also show that CECs respond to inflammatory stimuli coming from both the apical/blood and the basolateral/brain directions. As a result, CECs can detect factors secreted by pericytes in which the noncanonical inflammasome pathway is activated and respond with inflammatory activation and impairment of the barrier properties. In addition, upon sensing inflammatory signals, CECs release inflammatory factors toward both the blood and the brain sides. Consequently, CECs activate pericytes by upregulating their expression of NLRP3 (NOD-, LRR-, and pyrin domain-containing protein 3), an inflammasome-forming pattern recognition receptor. In conclusion, cerebral pericytes and endothelial cells mutually activate each other in inflammation

Paracellular and transcellular migration of metastatic cells through the cerebral endothelium

Breast cancer and melanoma are among the most frequent cancer types leading to brain metastases. Despite the unquestionable clinical significance, important aspects of the development of secondary tumours of the central nervous system are largely uncharacterized, including extravasation of metastatic cells through the blood-brain barrier. By using transmission electron microscopy, here we followed interactions of cancer cells and brain endothelial cells during the adhesion, intercalation/incorporation and transendothelial migration steps. We observed that brain endothelial cells were actively involved in the initial phases of the extravasation by extending filopodia-like membrane protrusions towards the tumour cells. Melanoma cells tended to intercalate between endothelial cells and to transmigrate by utilizing the paracellular route. On the other hand, breast cancer cells were frequently incorporated into the endothelium and were able to migrate through the transcellular way from the apical to the basolateral side of brain endothelial cells. When co-culturing melanoma cells with cerebral endothelial cells, we observed N-cadherin enrichment at melanoma-melanoma and melanoma-endothelial cell borders. However, for breast cancer cells N-cadherin proved to be dispensable for the transendothelial migration both in vitro and in vivo. Our results indicate that breast cancer cells are more effective in the transcellular type of migration than melanoma cells