Neurological disorders of gait, balance and posture are both debilitating and common. Adequate recognition of these so-called disorders of axial mobility is important as they can offer useful clues to the underlying pathology in patients with an uncertain clinical diagnosis, such as those early in the course of neurological disorders. Medical teaching programmes typically take classic clinical presentations as the starting point and present students with a representative constellation of features that jointly characterize a particular axial motor syndrome. However, patients rarely present in this way to a physician in clinical practice. Particularly in the early stages of a disease, patients might display just one (or at best only a few) abnormal signs of gait, balance or posture. Importantly, these individual signs are never pathognomonic for any specific disorder but rather come with an associated differential diagnosis. In this Perspective, we offer a new diagnostic approach in which the presenting signs are taken as the starting point for a focused differential diagnosis and a tailored search into the underlying neurological syndrome.

• MeSH
• lidé MeSH
• neurologické poruchy chůze diagnóza   patofyziologie   MeSH
• pohybové poruchy diagnóza   patofyziologie   MeSH
• postura těla fyziologie   MeSH
• posturální rovnováha fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: A high-quality research identifying the best physiotherapeutic approach for the improvement of balance in people with multiple sclerosis is missing. This study compared aspects of balance improvement such as therapy specificity to balance, therapy method and category, country, intensity and medical conditions. METHODS: A multicentric randomised rater-blinded controlled trial comprised three different physiotherapy programs (Czech and Italian outpatient or inpatient programs). All patients received 20 therapy sessions. Experimental group underwent balance specific physiotherapy (it was Motor Program Activating Therapy in the Czech cohort and Sensory-motor Integration Training in the Italian cohort), control group underwent non-balance specific physiotherapy (it was Vojta reflex locomotion in the Czech cohort and conventional dynamic strengthening exercises in the Italian cohort, respectively). Static balance was evaluated by Berg Balance Scale and dynamic balance was assessed by Timed Up-and-Go Test. RESULTS: A total of 149 patients entered the study. Physiotherapy significantly improved static balance (p < 0.0001, increase by mean 2.6 points (95% confidence interval 2.0-3.5) in BBS score). Balance specific approach had a higher effect than non-specific balance approach (increase in BBS by 1.9 points, 95% confidence interval 0.9-3.7 points). The intensity of the physiotherapy significantly influenced static balance (BBS by 2.7 points higher in the inpatient setting, p= 0.007). Dynamic balance was also improved (TUG decrease by -0.8 s (95% CI -1.4 - -0.1s, p = 0.011)); the balance specificity had no impact. The level of disability played the most important role (p= 0.022). CONCLUSION: Although the overall changes in static and dynamic balance were statistically significant, they were quite small in a clinical sense. A small statistically significant difference between balance specific and non-specific treatment was found. It seems that a high intensity of the therapy is critical to maximize the effectiveness.

• MeSH
• dospělí MeSH
• jednoduchá slepá metoda MeSH
• lidé středního věku MeSH
• lidé MeSH
• posturální rovnováha fyziologie   MeSH
• prospektivní studie MeSH
• roztroušená skleróza rehabilitace   MeSH
• senioři MeSH
• terapie cvičením metody   MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Background: Impaired balance is common in people with multiple sclerosis (MS) and can be present even in those with a mild disability level. With increasing disability, gait, and balance impairment progress, and lead to increased risk of falls. In some recent studies, interactive commercial video games were used for improving balance, but their limitation is their lack of individual training parameter settings needed for rehabilitation purposes. The aim of this study was to evaluate the feasibility and effect of balance exercise in the home setting using the rehabilitation Homebalance® system. Methods: A single-centre, controlled, single blind study with allocation to intervention group or to control group was utilised. Participants were assessed at baseline, after four weeks of home-based balance training, and follow-up after four weeks. The primary outcomes were the Berg Balance Test (BBT). The secondary outcome measures included the Mini-BESTest, Timed Up, and Go Test (part of Mini-BESTest), and spatio-temporal gait parameter evaluation using the GAITRite instrument. The patient reported outcomes (PRO) included the 12-Item MS Walking Scale, Activities-specific Balance Confidence Scale, and the Falls Efficacy Scale. Results: A total of 39 people with Multiple Sclerosis (10 men) were enrolled into the study. The mean age of participants was 40.69 ± 10.2 years, with a mean disease duration 14.76 ± 9.1 years and mean disability level 3.8 ± 1.9 EDSS (EDSS range 1.5-7). Statistically significant improvements within the home exercise group were present for the BBT and the Mini-BESTest. This improvement was more significant in the subgroup with moderate and higher disability (EDSS 4.5-7). All other gait parameters and PRO did not show any improvement. Follow-up assessment after four weeks showed that the reached improvement persisted for a short time period after finishing the regular training regimen. Conclusion: In comparison with no intervention, a short-term programme of home-based balance training using Homebalance® improved balance but not gait performance in a group of people with MS. It seems that home-based balance training tailored according to individual needs by a physiotherapist may be a future approach to consider for telerehabilitation of people with MS.

• Publikační typ
• časopisecké články MeSH

This paper presents a set of eleven functional Dynamic Neuromuscular Stabilization (DNS) tests corresponding with specific infantile developmental stages, clarifying desired postural-locomotion patterns from a developmental perspective, while also describing frequently-observed disturbances of these patterns.

• MeSH
• lidé MeSH
• lokomoce * MeSH
• posturální rovnováha * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: People with Multiple Sclerosis (PwMS) have a high incidence of accidental falls that have a potentially detrimental effect on their daily life participation. The effect of balance specific rehabilitation on clinical balance measures and frequency of falls in PwMS was studied. METHOD: A bi-centre randomised rater-blinded controlled trial. Participants in both groups received 20 treatment sessions. Participants in the intervention group received treatment aimed at improving balance and mobility. Participants in the control group received treatments to reduce limitations at activity and body function level. Primary measures were frequency of fallers (>1 fall in two months) and responders (>3 points improvement) at the Berg Balance Scale (BBS). Data was analysed according to an intention to treat approach. RESULTS: One hundred and nineteen participants were randomised. Following treatment frequency of fallers was 22% in the intervention group and 23% in the control group, odds ratio (OR) and (confidence limits): 1.05 (0.41 to 2.77). Responders on the BBS were 28% in the intervention group and 33% in the control group, OR = 0.75 (0.30 to 1.91). At follow up ORs for fallers and responders at BBS were 0.98 (0.48 to 2.01) and 0.79 (0.26 to 2.42), respectively. CONCLUSIONS: Twenty sessions 2-3 times/week of balance specific rehabilitation did not reduce fall frequency nor improve balance suggesting the need for more frequent and challenging interventions. Implications for Rehabilitation Programs for balance rehabilitation can improve balance but their effects in fall prevention are unclear. Twenty treatments sessions 2/3 times per week did not reduced frequency of falls in MS. The comparison with similar studies suggests that higher intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• posturální rovnováha fyziologie   MeSH
• roztroušená skleróza patofyziologie   rehabilitace   MeSH
• techniky fyzikální terapie * MeSH
• úrazy pádem prevence a kontrola   statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

V klinické praxi jsou používány dva přístupy k hodnocení acidobazického stavu organismu: tradiční (bicarbonate-centered), jenž je založen na Hendersonově-Hasselbalchově disociační rovnici kyseliny uhličité doplněné výpočtem aniontové mezery, a novější kvantitativní dle Stewarta-Fencla, který definuje tři nezávisle proměnné veličiny, jejichž změny určují pH. Jsou to: rozdíl mezi součtem nábojů nesených silnými kationty a silnými anionty plazmy (SID – strong ion difference: sníží-li se, vznikne acidóza a naopak), celková koncentrace slabých neprchavých kyselin ([Atot] – anorganický fosfát a albumin: sníží-li se, vznikne alkalóza a naopak) a pCO2. Dle tohoto přístupu jsou pH i hydrogenkarbonát tzv. závisle proměnné, jejichž koncentrace se mění tehdy a jen tehdy, když se změní nezávisle proměnné veličiny. Hlavní předností Stewartova-Fenclova přístupu je výpočet plazmatické koncentrace aniontů silných kyselin, které běžně nestanovujeme a na jejichž přítomnost usuzujeme při tradičním přístupu z aniontové mezery. Korekce hodnoty aniontové mezery na plazmatickou koncentraci albuminu zvyšuje její výpovědní hodnotu. Tato úprava přibližuje tradiční přístup k novějšímu Stewartovu-Fenclovu přístupu, který přesně vypočte množství silných aniontů tak, že aniontovou mezeru korigovanou na albumin dále upřesní podle plazmatické koncentrace fosfátů, kalcia a magnezia. To má význam zejména u kriticky nemocných v metabolickém rozvratu, kdy tradiční přístup vždy neodhalí přítomnost nestanovených aniontů silných kyselin. Posouzení rozdílu mezi sérovými koncentracemi natria a chloridů upozorní na poruchu acidobazické rovnováhy v důsledku odchylky SID.

Two approaches have been used in clinical evaluation the acid-base status: traditional (bicarbonate-centered) is based on the Henderson-Hasselbalch equation complemented by calculation of the anion gap, and more recent quantitative approach proposed by Stewart and Fencl. The latter method defines the three independent variables, which regulate pH. These include: the difference between the sum of charges carried by strong plasma cations and anions termed the strong ion difference – SID (decrease causes acidosis, and vice versa); the total concentration of the weak non-volatile acids − [Atot] (inorganic phosphate and albumin, decrease causes alkalosis and vice versa), and pCO2. According to this approach, pH and bicarbonate are dependent variables. Their concentrations change if and only if one or more independent variables are altered. The main advantage of the Stewart-Fencl approach is the calculation of the concentration of plasma acids, which are not routinely measured. In the traditional approach, their presence is inferred from the anion gap. The correction of the value of anion gap according to the serum albumin level increases the specificity. This correction brings traditional approach closer to the Stewart-Fencl method that precisely calculates unmeasured strong anions by further adjustment of the corrected anion gap according to the serum phosphate, calcium and magnesium levels. The precise calculation of unmeasured anions is important in critically ill patients with the metabolic breakdown, where the traditional approach may overlook the presence of unmeasured anions. Consideration of the sodium-chloride difference draws the attention to acid-base disturbance caused by change of the strong ion difference.

• Klíčová slova
• Stewartova-Fenclova teorie, silné anionty, hydrogenkarbonátový ion,
• MeSH
• acidobazická rovnováha fyziologie   MeSH
• acidóza diagnóza   MeSH
• anionty * MeSH
• biologické modely * MeSH
• chloridy krev   MeSH
• hydrogenuhličitany krev   MeSH
• ionty MeSH
• koncentrace vodíkových iontů MeSH
• lidé MeSH
• poruchy acidobazické rovnováhy * diagnóza   metabolismus   MeSH
• sérový albumin analýza   MeSH
• sodík krev   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

The transcription factor c-Myc, a key regulator of cellular processes, has long been associated with roles in cell proliferation and apoptosis. This review analyses the multiple functions of c-Myc by examining the different c-Myc isoforms in detail. The impact of different c-Myc isoforms, in particular p64 and p67, on fundamental biological processes remains controversial. It is necessary to investigate the different isoforms in the context of proto-oncogenesis. The current knowledge base suggests that neoplastic lesions may possess the means for self-destruction via increased c-Myc activity. This review presents the most relevant information on the c-Myc locus and focuses on a number of isoforms, including p64 and p67. This compilation provides a basis for the development of therapeutic approaches that target the potent growth arresting and pro-apoptotic functions of c-Myc. This information can then be used to develop targeted interventions against specific isoforms with the aim of shifting the oncogenic effects of c-Myc from pro-proliferative to pro-apoptotic. The research summarised in this review can deepen our understanding of how c-Myc activity contributes to different cellular responses, which will be crucial in developing effective therapeutic strategies; for example, isoform-specific approaches may allow for precise modulation of c-Myc function.

• MeSH
• apoptóza * MeSH
• messenger RNA MeSH
• proliferace buněk MeSH
• protein - isoformy genetika   MeSH
• protoonkogenní proteiny c-myc * genetika   MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Poruchy iontového hospodářství jsou častou a velmi závažnou situací, která se vyskytuje ve stáří. Příčiny poruch vodního a iontového hospodářství jsou založeny na snížené schopnosti starších jedinců adaptovat se na patologické změny v průběhu onemocnění i na zátěž zevního prostředí. Přístup k tomuto typu poruch se v posledních letech výrazně změnil, zejména z hlediska iontového a vodního hospodářství k aspektům intermediárního metabolismu a energetické rovnováhy v průběhu onemocnění. Z tohoto pohledu je úprava vodního a minerálního hospodářství velmi závislá na nutriční podpoře a energetickém zajištění pacienta. Některé z hlavních iontů, např. hořčík a fosfor, získávají v pohledu na onemocnění starších jedinců zvláštní význam a jejich poruchy se podílejí na vzniku klinické situace, kterou shrnujeme pod obrazem „křehký pacient“. Nový moderní přístup a odlišnosti léčby vodního a iontového hospodářství mají zvláštní důležitost v intenzivní péči a v řešení urgentních stavů. Cílem článku je zdůraznit některé odlišnosti nového pohledu na léčbu poruch vodní a iontové rovnováhy se zvláštním zřetelem na odlišnosti ve stáří.

The water and electrolyte disorders are a frequently occurring and serious condition occurring in the old age. The causes of the water and electrolyte disorders are based on decreased capability of elderly individuals to adapt themselves to the pathological changes in the course of disease as well as to the effects of the outer environment. Approaches to this type of disturbances have markedly changed in recent years, in particular from electrolyte and water management towards the aspects of the intermediary metabolism in the course of disease. From this standpoint, adjustments of water and mineral management are dependent very much on nutritional support and energy balance of the patient. Some of the principal electrolytes, e.g. potassium and phosphorus, are of special importance in the view of the diseases of elderly individuals. These disorders participate in the development of clinical situation summarized under the term “a fragile patient.” A new modern approach and differences in the treatment of water and electrolyte management are of special importance in intensive care and resolution of urgent conditions. The paper aims to emphasize some differences in the new views on the treatment of disorders of water and electrolyte balance with special regard to the specifics of the geriatric patients.

• MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• věkové faktory MeSH
• vodní a elektrolytová nerovnováha * etiologie   terapie   MeSH
• vodní a elektrolytová rovnováha účinky léků   MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Surface energy is extensively adopted to predict the surface properties of materials nowadays. Our study was aimed at utilizing the surface free energy measured by inverse gas chromatography to determine inter-particle interactions and to describe the overall behaviour of mixtures. The model drugs of different solubility (tadalafil, levocetirizine dihydrochloride, vardenafil hydrochloride, and amlodipine besylate) and two grades of polyvinylpyrrolidone (Kollidon® 12 PF, Kollidon® VA 64) were mixed in various ratios. Investigated components were characterized using inverse gas chromatography, particle size distribution and specific surface area. We also determined the work of adhesion and cohesion between the components in the binary mixtures. Due to the formation of levocetirizine agglomerates, the effect of mixing time on both components of the surface free energy was also studied for the binary mixture with Kollidon® VA 64. The results based on the energy analysis, especially positive or negative excess surface energies in theoretical and real binary mixtures, indicate that we can predict whether the components can form the desired ordered (interactive) mixture. For this reason, we have proposed, to the best of our knowledge, different approach to predict the interactions between components and their behaviour in the binary mixtures using inverse gas chromatography in terms of the energy balance based only on the surface parameters (surface free energy, dispersive and specific surface energy). Therefore, the approach of energy balance is an innovative and comparatively simple tool for analysis and identification of interactions between components in particulate systems, which can also predict the quality of the mixing.

• MeSH
• chromatografie plynová metody   MeSH
• léčivé přípravky analýza   metabolismus   MeSH
• lékové interakce fyziologie   MeSH
• polymery analýza   farmakokinetika   MeSH
• předpověď MeSH
• velikost částic MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Functional electric stimulation (FES) is recommended for foot drop in multiple sclerosis, although little is known about its therapeutic effect. AIM: The aim of this study is to evaluate a therapeutic effect immediately and two months after program termination (persistent and delayed effect) of a new approach using FES in combination with correcting the patients' postural system. More specifically, we evaluate the effects of this approach on the patients' clinical functions and compared it with individual physiotherapy. DESIGN: Parallel randomized blind trial. SETTING: Two-month-long treatments, functional electric stimulation in posturally corrected position (group 1) and neuroproprioceptive facilitation and inhibition physiotherapy called motor program activating therapy (group 2). POPULATION: Forty-four subjects with multiple sclerosis. METHODS: Primary outcomes: gait (the 2-Minute Walk Test; Timed 25-Foot Walk test; Multiple Sclerosis Walking Scale-12) and balance (by e.g. Berg Balance Scale [BBS], the Activities-Specific Balance Confidence Scale [ABC], Timed Up-and-Go Test [TUG]). SECONDARY OUTCOMES: mobility, cognition, fatigue and subjects' perceptions (e.g. Multiple Sclerosis Impact Scale [MSIS], Euroqol-5 dimensions-5 levels [EQ-5D-5L]). RESULTS: Group 1 showed immediate therapeutic effect in BBS (P=0.008), ABC (P=0.04) and EQ-5D-5L (self-care, P=0.019, mobility P=0.005). The improvement in EQ-5D-5L persisted and in TUG-cognitive we documented a delayed effect (P=0.005). Group 2 showed an immediate improvement in BBS (P=0.025), MSIS (P=0.043) and several aspects of daily life (the effect on health today was significantly higher than in group 1, significant difference between groups P=0.038). CONCLUSIONS: FES in the posturally corrected position has an immediate therapeutic effect on balance and patients' perceptions comparable to motor program activating therapy, and higher persistent and even delayed therapeutic effect. CLINICAL REHABILITATION IMPACT: The study results point to the importance of correcting the patients' posture when applying FES, the possibility to treat foot drop by individual physiotherapy and the activation of the patients' auto reparative processes.

• MeSH
• dospělí MeSH
• elektrostimulační terapie metody   MeSH
• jednoduchá slepá metoda MeSH
• lidé středního věku MeSH
• lidé MeSH
• neurologické poruchy chůze terapie   MeSH
• neuropatie nervus peroneus terapie   MeSH
• posturální rovnováha fyziologie   MeSH
• posuzování pracovní neschopnosti MeSH
• roztroušená skleróza terapie   MeSH
• test chůzí MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH