Celiac disease (gluten-sensitive enteropathy) is an immune mediated disorder with characteristic histopathological small bowel mucosal changes that respond to a strict gluten-free diet. Recent studies have suggested that complete (rather than partial) mucosal recovery and healing is possible, but in some this may require a more prolonged period than is currently appreciated. In this study, 182 patients (60 males, 122 females) referred for evaluation of symptoms, including diarrhea and weight loss, were selected only if initial biopsies showed characteristic inflammatory changes with severe architectural disturbance. All patients were treated with a strict gluten diet alone and diet compliance regularly monitored. Up to 90% or more of patients showed a complete mucosal response or healing. A time-dependent rate of response was noted with most patients requiring more than 1 year, and even 2 years or more, to respond, however, complete mucosal healing was still possible within 6 months. In this evaluation, females in each of 4 different age ranges had mucosal response and healing rates superior to males, while elderly celiacs had lower rates. Such factors should be considered before labeling a patient with “non-responsive” disease. However, inflammatory changes with persistent architectural disturbance, especially in celiacs with a late diagnosis and resultant late initiation of a gluten-free diet treatment, may be at increased risk for a later small bowel complication, including lymphoma.

• MeSH
• bezlepková dieta MeSH
• celiakie * patofyziologie   MeSH
• dítě MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• senioři MeSH
• sliznice * patofyziologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

Cíl studie: Cílem předkládané práce byla snaha o objasnění role a významu hypocholesterolemie vznikající u nemocných v klinicky závažných stavech. Jedná se o monocentrickou, prospektivní klinickou studii. Materiál a metody: Do studie byly zařazeny 2 skupiny nemocných - jednak skupina pacientů s kardiovaskulárním onemocněním, u kterých byla plánována revaskularizační operace bez použití mimotělního oběhu (n = 17), a jednak skupina nemocných, kteří utrpěli polytrauma (n = 19). Celkem bylo do studie zařazeno 36 nemocných. Mimo standardní biochemická vyšetření (celkový cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceridy, C-reaktivní protein, total protein, albumin, prealbumin) bylo provedeno stanovení sterolů (ß-sitosterol, campesterol, lathosterol, skvalen), interleukinu IL-6 a kortizolu. Dále byl proveden ACTH test a stanovena funkční zdatnost granulocytů pomocí testu oxidativního vzplanutí granulocytů. Odběry byly provedeny v den přijetí, 1., 4. a 8. den po výkonu. Výsledky: Ve sledovaných skupinách došlo k statisticky významnému poklesu celkového cholesterolu (TC) a LDL-cholesterolu s úpravou do výchozích hodnot v průběhu sledovaného období. Společně s poklesem celkového cholesterolu byl zaznamenán pokles jeho syntézy (lathosterol a poměr lathosterol/cholesterol). Byla pozorována vysoce signifikantní negativní korelace mezi IL-6 a celkovým cholesterolem. Přestože nebyla zjištěna porucha funkce nadledvin, byla nalezena signifikantně pozitivní korelace poměru lathosterol/cholesterol (jako markeru de novo syntézy) s kortizolem po ACTH stimulačním testu. V závislosti na hladině cholesterolu byla prokázána statisticky významná porucha baktericidie leukocytů pomocí stimulovaného testu oxidativního vzplanutí granulocytů. Závěr: U nemocných v akutních stavech dochází k poklesu endogenní syntézy cholesterolu. Míra syntézy cholesterolu negativně koreluje s plazmatickou hladinou IL-6. Míra endogenní syntézy cholesterolu pozitivně koreluje se syntézou kortizolu v nadledvinách a s baktericidní schopností granulocytů.

Objective: The aim of the study was to elucidate the role and importance of hypocholesterolemia in clinically serious conditions. It was a monocentric, prospective clinical study. Material and Methods: Two groups of patients were recruited to the study – one group were patients with coronary heart disease (CHD), who underwent miniinvasive cardiosurgical operation without extracorporeal circulatio ?(n = 17) and one group of patients, who sustain polytrauma (n = 19). Thirty six patients were recruited into the study. We performed the determination of sterols (total cholesterol, HDL-cholesterol, LDL-cholesterol, triacylglycerols), and their precursors (ß-sitosterol, campesterol, lathosterol, skvalen), interleukin IL-6 and cortisol in the blood serum. The short version of ACTH stimulation test was performed. The oxidative burst of granulocytes was evaluated. The blood samples were taken on the day of admission, the first, the fourth and the eighth post-operative and post-traumatic day. Results: There was a significant decline of total cholesterol (TC) and LDL-cholesterol level with full recovery during observed period. There was a decline of cholesterol synthesis (lathosterol and lathosterol/cholesterol ratio) together with a decline of total cholesterol. There was a significantly negative correlation between IL-6 level and total cholesterol. Despite no confirmation of disturbance of adrenal function, there was a significantly positive correlation between lathosterol/cholesterol ratio ?(a de novo cholesterol synthesis marker) and cortisol level after the ACTH stimulation test. There was a significant breakdown of bactericidal function of granulocytes along with a decline of cholesterol level. Conclusion: There was decline of endogenous cholesterol synthesis in clinically serious conditions. The cholesterol synthesis rate is negatively influenced by IL-6 level. The rate of endogenous cholesterol synthesis positively correlated with cortisol production by the adrenals and with bactericidal function of granulocytes.

• Klíčová slova
• hypocholesterolemie, SIRS, revaskularizace,
• MeSH
• cholesterol biosyntéza   krev   MeSH
• cytokiny MeSH
• dospělí MeSH
• fyziologický stres MeSH
• hydrokortison metabolismus   MeSH
• hypolipoproteinemie MeSH
• interleukin-6 krev   MeSH
• koronární nemoc chirurgie   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polytrauma metabolismus   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• adaptace psychologická MeSH
• afektivní symptomy MeSH
• charakteristiky rodiny MeSH
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• poruchy sociálního chování MeSH
• školy MeSH
• sociální problémy MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH

KEY POINTS: Spinal treatment can restore diaphragm function in all animals 1 month following C2 hemisection induced paralysis. Greater recovery occurs the longer after injury the treatment is applied. Through advanced assessment of muscle mechanics, innovative histology and oxygen tension modelling, we have comprehensively characterized in vivo diaphragm function and phenotype. Muscle work loops reveal a significant deficit in diaphragm functional properties following chronic injury and paralysis, which are normalized following restored muscle activity caused by plasticity-induced spinal reconnection. Injury causes global and local alterations in diaphragm muscle vascular supply, limiting oxygen diffusion and disturbing function. Restoration of muscle activity reverses these alterations, restoring oxygen supply to the tissue and enabling recovery of muscle functional properties. There remain metabolic deficits following restoration of diaphragm activity, probably explaining only partial functional recovery. We hypothesize that these deficits need to be resolved to restore complete respiratory motor function. ABSTRACT: Months after spinal cord injury (SCI), respiratory deficits remain the primary cause of morbidity and mortality for patients. It is possible to induce partial respiratory motor functional recovery in chronic SCI following 2 weeks of spinal neuroplasticity. However, the peripheral mechanisms underpinning this recovery are largely unknown, limiting development of new clinical treatments with potential for complete functional restoration. Utilizing a rat hemisection model, diaphragm function and paralysis was assessed and recovered at chronic time points following trauma through chondroitinase ABC induced neuroplasticity. We simulated the diaphragm's in vivo cyclical length change and activity patterns using the work loop technique at the same time as assessing global and local measures of the muscles histology to quantify changes in muscle phenotype, microvascular composition, and oxidative capacity following injury and recovery. These data were fed into a physiologically informed model of tissue oxygen transport. We demonstrate that hemidiaphragm paralysis causes muscle fibre hypertrophy, maintaining global oxygen supply, although it alters isolated muscle kinetics, limiting respiratory function. Treatment induced recovery of respiratory activity normalized these effects, increasing oxygen supply, restoring optimal diaphragm functional properties. However, metabolic demands of the diaphragm were significantly reduced following both injury and recovery, potentially limiting restoration of normal muscle performance. The mechanism of rapid respiratory muscle recovery following spinal trauma occurs through oxygen transport, metabolic demand and functional dynamics of striated muscle. Overall, these data support a systems-wide approach to the treatment of SCI, and identify new targets to mediate complete respiratory recovery.

• MeSH
• bránice * MeSH
• kinetika MeSH
• krysa rodu rattus MeSH
• kyslík MeSH
• lidé MeSH
• mícha MeSH
• nervus phrenicus MeSH
• obnova funkce MeSH
• poranění míchy * MeSH
• potkani Sprague-Dawley MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Health-related quality of life (HRQL) is an important goal for patients with major depressive disorder (MDD), but whether antidepressants improve HRQL in these patients is unclear. Here, we describe the real-world effects of trazodone once-a-day (TzOAD) and selective serotonin reuptake inhibitor (SSRI) treatments on HRQL and functioning in adults with MDD. METHODS: This 8-week prospective, observational, open-label, multicenter study was conducted in adults with moderate or severe MDD for whom TzOAD or SSRI were prescribed as monotherapy. The primary outcome was life enjoyment and satisfaction assessed via the patient-reported Quality-of-Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) from baseline to week 8. Secondary outcomes included change in Q-LES-Q-SF from baseline to weeks 1 and 2; severity of depressive symptoms using the Montgomery Åsberg Depression Rating Scale (MADRS) and sleep disturbance via the PROMIS SF-SD 8b questionnaire at weeks 1, 2, and 8; and overall functioning via the Sheehan Disability Scale (SDS), hedonic capacity using the Snaith-Hamilton Pleasure Scale (SHAPS), and cognitive dysfunction using the Perceived Deficits Questionnaire (PDQ-5) at baseline and week 8. RESULTS: The study included 208 adults with MDD (mean [SD] age = 50.2 [14.3] years; 68.6% female; 98.4% White). Life enjoyment and satisfaction improved from baseline to week 8 for both treatment groups: Q-LES-Q-SF mean (SD) scores were 27.5 (20.4) for the SSRI group and 39.0 (22.1) for the TzOAD group. Depressive symptoms and sleep disturbances also reduced from baseline to week 8: MADRS (SSRI, -15.7 [8.3]; TzOAD, -21.0 [9.8]); PROMIS SF-SD 8b (SSRI, -9.9 [12.6]; TzOAD, -22.0 [12.6]). Mean change scores in Q-LES-Q-SF, MADRS, and PROMIS SF-SD 8b improved as early as week 1 in both groups. Mean scores also improved from baseline to week 8 on SDS (SSRI, -9.2 [7.4]; TzOAD, -14.3 [7.5]), SHAPS (SSRI, -6.6 [4.3]; TzOAD, -8.3 [4.4]), and PDQ-5 (SSRI, -5.8 [4.5]; TzOAD, -7.7 [5.0]). CONCLUSIONS: In adults with MDD who received TzOAD or SSRIs, overall and individual HQRL domains improved rapidly and in parallel with improvements in depressive symptoms, with a slightly greater improvement observed in the TzOAD group.

• MeSH
• antidepresiva druhé generace aplikace a dávkování   terapeutické užití   farmakologie   MeSH
• depresivní porucha unipolární * farmakoterapie   patofyziologie   MeSH
• dospělí MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce účinky léků   MeSH
• prospektivní studie MeSH
• selektivní inhibitory zpětného vychytávání serotoninu * aplikace a dávkování   farmakologie   MeSH
• trazodon * farmakologie   aplikace a dávkování   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.

• MeSH
• bolest etiologie   MeSH
• dospělí MeSH
• extrakce zubů škodlivé účinky   MeSH
• hypestezie etiologie   MeSH
• lidé MeSH
• mandibula chirurgie   MeSH
• molár třetí * chirurgie   MeSH
• percepce MeSH
• pooperační bolest etiologie   MeSH
• prospektivní studie MeSH
• zaklíněný zub * chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Pacienti s bipolární poruchou mají vážně narušené cirkadiánní rytmy. Změny v cyklu spánek/bdění a struktuře spánku, denní profily tělesné teploty, kortizolu, thyrotropinu, prolaktinu, růstového hormonu, melatoninu a vylučování různých metabolitů v rnoči, jsou narušeny u osob s bipolární poruchou. Ukazuje se, že úprava těchto rytmů souvisí se zotavením pacienta. Léčba stabilizátory nálady může tyto denní rytmy obnovit. Stále je však nejasné, zda abnormality v cirkadiánních rytmech jsou příčinou bipolární poruchy, nebo jsou tato narušení jen druhotnou změnou odrážející narušení v jiných systémech. Nicméně výzkum cirkadiánních rytmů vedl k vytvoření nefarmakologická terapie bipolárních pacientů, která může pomoci při léčbě deprese nebo mánie. Tyto strategie, pojmenované jako chronoterapie, jsou založeny na kontrolovaných expozicích vůči podnětům prostředí, které synchronizují cirkadiánní rytmy. Tyto postupy prokázaly dobrou účinnost v léčbě epizod. Sem patří manipulace se spánkem (jako je částečná a celková spánková deprivace nebo fázový předstih spánku) a léčba světlem či léčba tmou.

Patients with bipolar disorder have severely disrupted circa- dian rhythms. Alteration of the sleep-wake cycle and of the sleep structu- re are core symptoms of a bipolar disorder. Many other circadian rhyth- ms, such as the daily profiles of body temperature, cortisol, thyrotropin, prolactin, growth hormone, melatonin and excretion of various meta- bolites in the urine, are disrupted in bipolar individuals. These disrup- ted rhythms seem to return to normality with patient recovery. Treat- ment with mood stabilizers can restore these daily rhythms, and this is correlated with patient recovery. However, it is still uncertain whether clock abnormalities are the cause of bipolar disorder or if these rhythm disruptions are secondary to alterations in other circuits. Nevertheless research on circadian rhythms and sleep have led to the definition of nonpharmacological ther apies of bipolar disorder that can help in depres- sion or in mania. These strat egies, named chronotherapeutics, are based on controlled exposures to environmental stimuli that act on biologi- cal rhythms, and demonstrate good efficacy in the treatment of illness episodes. They include manipulations of the sleep-wake rhythm (such as partial and total sleep deprivation, and sleep phase advance) and of the exposure to the light-dark cycle (light therapy and dark therapy).

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• adaptace psychologická MeSH
• poruchy chování u dětí MeSH
• poruchy přizpůsobení MeSH
• sociální přizpůsobení MeSH

• MeSH
• adaptace psychologická MeSH
• dítě MeSH
• lidé MeSH
• poruchy přizpůsobení terapie   MeSH
• psychoterapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

x

x

• MeSH
• adaptace psychologická * MeSH
• lidé MeSH
• obranné mechanismy MeSH
• poruchy přizpůsobení MeSH
• socializace * MeSH
• vězni * psychologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH