1. Brain dynamics underlying preserved cycling ability in patients with Parkinson’s disease and freezing of gaitTeja Ličen, Martin Rakuša, Nicolaas I. Bohnen, Paolo Manganotti, Uroš Marušič, 2022, review article Abstract: Parkinson’s disease (PD) is generally associated with abnormally increased beta band oscillations in the cortico-basal ganglia loop during walking. PD patients with freezing of gait (FOG) exhibit a more distinct, prolonged narrow band of beta oscillations that are locked to the initiation of movement at ∼18 Hz. Upon initiation of cycling movements, this oscillation has been reported to be weaker and rather brief in duration. Due to the suppression of the overall beta band power during cycling and its continuous nature of the movement, cycling is considered to be less demanding for cortical networks compared to walking, including reduced need for sensorimotor processing, and thus unimpaired continuous cycling motion. Furthermore, cycling has been considered one of the most efficient non-pharmacological therapies with an influence on the subthalamic nucleus (STN) beta rhythms implicative of the deep brain stimulation effects. In the current review, we provide an overview of the currently available studies and discuss the underlying mechanism of preserved cycling ability in relation to the FOG in PD patients. The mechanisms are presented in detail using a graphical scheme comparing cortical oscillations during walking and cycling in PD.
Keywords: gait, freezing of gait, Parkinson's disease, cycling, cortical oscillations, beta band
Published in DKUM: 04.12.2024; Views: 0; Downloads: 2
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2. European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1 : role of opioids in the management of chronic noncancer painWinfried Hauser, Bart Morlion, Kevin E. Vowles, Kirsty Bannister, Eric Buchser, Roberto Casale, Jean-François Chenot, Gillian Chumbley, Asbjørn M. Drewes, Gert Dom, Liisa Jutila, Tony O'Brien, Esther Pogatzky-Zahn, Martin Rakuša, Carmen Suarez-Serrano, Thomas Tölle, Nevenka Krčevski-Škvarč, 2021, original scientific article Abstract: Background: Opioid use for chronic non-cancer pain (CNCP) is complex. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC).
Methods: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment.
Results: The key clinical practice recommendations suggest: (a) first optimizing established non-pharmacological treatments and non-opioid analgesics and (b) considering opioid treatment if established non-pharmacological treatments or non-opioid analgesics are not effective and/or not tolerated and/or contraindicated. Evidence- and clinical consensus-based potential indications and contraindications for opioid treatment are presented. Eighteen GCP recommendations give guidance regarding clinical evaluation, as well as opioid treatment assessment, monitoring, continuation and discontinuation.
Conclusions: Opioids remain a treatment option for some selected patients with CNCP under careful surveillance.
Significance: In chronic pain, opioids are neither a universal cure nor a universally dangerous weapon. They should only be used for some selected chronic noncancer pain syndromes if established non-pharmacological and pharmacological treatment options have failed in supervised pain patients as part of a comprehensive, multi-modal, multi-disciplinary approach to treatment. In this context alone, opioid therapy can be a useful tool in achieving and maintaining an optimal level of pain control in some patients.
Keywords: pain, cronic disease, analgesia, opioid analgesics
Published in DKUM: 16.08.2024; Views: 69; Downloads: 9
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3. COVID-19 vaccination hesitancy among people with chronic neurological disorders : a position paperMartin Rakuša, Serefnur Öztürk, Elena Moro, Raimund Helbok, Claudio Bassetti, Ettore Beghi, Daniel Bereczki, Benedetta Bodini, Giovanni Di Liberto, Tom Jenkins, 2022, original scientific article Abstract: Background and purpose
Health risks associated with SARS-CoV-2 infection are undisputed. Moreover, the capability of vaccination to prevent symptomatic, severe, and fatal COVID-19 is recognized. There is also early evidence that vaccination can reduce the chance for long COVID-19. Nonetheless, the willingness to get vaccinated and receive booster shots remains subpar among people with neurologic disorders. Vaccine scepticism not only jeopardizes collective efforts to end the COVID-19 pandemic but puts individual lives at risk, as some chronic neurologic diseases are associated with a higher risk for an unfavorable COVID-19 course.
Methods
In this position paper, the NeuroCOVID-19 Task Force of the European Academy of Neurology (EAN) summarizes the current knowledge on the prognosis of COVID-19 among patients with neurologic disease, elucidates potential barriers to vaccination coverage, and formulates strategies to overcome vaccination hesitancy. A survey among the Task Force members on the phenomenon of vaccination hesitancy among people with neurologic disease supports the lines of argumentation.
Results
The study revealed that people with multiple sclerosis and other nervous system autoimmune disorders are most skeptical of SARS-CoV-2 vaccination. The prevailing concerns included the chance of worsening the pre-existing neurological condition, vaccination-related adverse events, and drug interaction.
Conclusions
The EAN NeuroCOVID-19 Task Force reinforces the key role of neurologists as advocates of COVID-19 vaccination. Neurologists need to argue in the interest of their patients about the overwhelming individual and global benefits of COVID-19 vaccination. Moreover, they need to keep on eye on this vulnerable patient group, its concerns, and the emergence of potential safety signals.
Keywords: advocacy, COVID-19, infectious disease prevention, neurological disorders, SARS-CoV-2, vaccination, vaccine skepticism
Published in DKUM: 02.07.2024; Views: 149; Downloads: 9
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4. Razvoj au nanodelcev z metodo ultrazvočne razpršilne pirolize za detekcijo protiteles proti SARS-CoV-2 : doktorska disertacijaŽiga Jelen, 2023, doctoral dissertation Abstract: V doktorskem delu so predstavljene študije, eksperimentalno delo, tehnike karakterizacije, rezultati in analize, s pomočjo katerih smo potrdili hipotezo, da je možno Au nanodelce (AuND) pripravljene z metodo ultrazvočne razpršilne pirolize (USP), konjugirati s ciljnimi antigeni SARS-CoV-2 in rekombinantnim IgG, da bodo delovali v imunoserološkem hitrem testu na lateralni tok (LFIA), za potrditev potencialne prisotnosti protiteles proti virusu SARS-CoV-2. S ciljno izbranimi parametri (0,5 g/l Au, 5 l/min N2, 2,5 l/min H2) smo z USP sintetizirali AuND iz prekurzorja na osnovi zlatovega (III) klorida. AuND smo zbirali v steklenicah z demineralizirano vodo. Določili smo optimalne stabilizatorje in njihove koncentracije: 2,5 g/L PVP 40K ((C6H9NO)n) ter naknadno dodani 1 g/L trinatrijevega citrata (Na3C6H5O7) in saharoze (C12H22O11), da bi preprečili AuND aglomeracijo. Presevna elektronska mikroskopija AuND je pokazala, da so okrogli, s povprečno velikostjo okoli 50 nm in ozko velikostno porazdelitvijo, brez defektov in nizkim ZETA potencialom, 2,4 mV, pri pH 7,5. Za odstranitev vode iz suspenzije z AuND in stabilizatorji je bila uporabljena liofiliazcija, ki je bila izvedena pri naslednjih pogojih: zamrzovanje pri –40 °C, 4 h, atmosferski tlak; primarno sušenje pri +20 °C, 12 h, 1–4 Pa; sekundarno sušenje pri +30 °C, 33 h, 1–4 Pa. Nastali posušeni AuND so ohranili vse lastnosti, ki so potrebne za funkcijo oznak v hitrih LFIA testih: visoka površinska energija, površinska plazmonska resonanca in proste karboksilne skupine za konjugacijo.
V nadaljevanju izvajanja eksperimentov smo, da bi potrdili doktorske hipoteze, izvedli raziskavo in optimizacijo konjugacije AuND z antigenom SARS-CoV-2, ki je bodičasti protein S1 (ak 1-681), in s protitelesi na zajčji IgG (RMG03). Za določitev poteka konjugacije AuND smo uporabili posredne (gelske elektroforeze, UV-Vis, preizkus delovanja) in direktne (XPS, SIMS) metode. Rezultati so pokazali, da se med našim postopkom konjugacije, v fazah čiščenja odstranimo večinski delež PVP in saharoze, ter s tem sprostimo proste karboksilne funkcionalne skupine citratnih ionov, ki so vezani na povšini AuND. Na teh prostih mestih lahko poteče konjugacija prek prostih -NH2 skupin na proteinih. Njihovo funkcionalnost smo ovrednotili z eksperimentalnimi testiranji lastno razvitega LFIA testa. Na osnovi tega smo postavili model in mehanizem konjugacije AuND, ki predpostavlja, da poteka konjugacija z antigeni oziroma protitelesi prek tvorbe peptidnih vezi med N-koncem proteina in prostimi karboksilnimi skupinami citratnega iona, ki je vezan na površino AuND prek svojih karboksilnih skupin.
Za dodatno potrditev funkcionalizacije AuND z izbranimi biomolekulami smo v sklepnem delu doktorskega dela izvedli klinično študijo na pacientih UKC MB, ki je bila odobrena s sklepom KME RS št. 0120-148/2021/3. Rezultati študije so pokazali, da testi dosegajo visoko občutljivost (83 %) tako na vzorcih nosnega sluza kot na vzorcih seruma, slabšo specifičnost (66 % sluz, 74 % serum), visoko negativno napovedno vrednost (94 %) in slabšo pozitivno napovedno vrednost (38 % sluz, 45 % serum). S študijo smo potrdili delovanje AuND v funkciji oznak, saj so se testne in kontrolne linije v lastno razvitem LFIA hitrem testu obarvale.
Keywords: Nanodelci zlata, SARS-CoV-2 virus, stabilizacija, konjugacija, LFIA testi, karakterizacija
Published in DKUM: 28.03.2024; Views: 347; Downloads: 47
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6. Vpliv sprostitvenih tehnik na počutje žensk z multiplo sklerozoMaruša Koren, 2022, undergraduate thesis Abstract: Uvod: Multipla skleroza je kronična avtoimuna bolezen, ki najpogosteje prizadene ženske v rodni dobi. Sprostitvene tehnike se uporabljajo kot dopolnilna terapija za obvladovanje stresa, depresije, tesnobe in bolečine pri osebah z multiplo sklerozo. Namen zaključnega dela je ugotoviti, kako sprostitvene tehnike vplivajo na počutje žensk, obolelih s progresivno multiplo sklerozo.
Metode: Opravili smo narativni pregled strokovne in znanstvene literature. Poiskali smo članke v angleškem jeziku, v podatkovnih bazah PubMed, MEDLINE, CHINAL, Wiley Online Library, Science Direct ter iskalniku Google Učenjak. Potek iskanja literature smo predstavili s pomočjo PRISMA diagrama. Naredili smo sintezo zbranih virov z uporabo metodo tematske analize.
Rezultati: V končno analizo smo vključili 16 člankov. Ugotovili smo, da sprostitvene tehnike izboljšujejo negativne posledice multiple skleroze, kot so stres, depresija, anksioznost, bolečina ter utrujenost.
Razprava in sklep: Sprostitvene tehnike dobro vplivajo na počutje žensk s progresivno multiplo sklerozo. Pri ženskah, ki so uporabile te tehnike, se je zmanjšal stres, depresija, bolečina, utrujenost, spanec se je izboljšal. Sprostitvene tehnike lahko izboljšajo kakovost življenja ter zmanjšajo negativne posledice multiple skleroze
Keywords: Ženske, progresivna multipla skleroza, sprostitvene tehnike, dobro počutje.
Published in DKUM: 16.03.2023; Views: 612; Downloads: 164
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8. Predlog prenove procesa trombolitičnega zdravljenja možganske kapiGorana Krajnc Burić, 2021, master's thesis Abstract: Izhodišče: Možganska kap nastane nenadoma, brez opozorila in hudo prizadene osebo. Namen raziskave je bil posneti obstoječi proces trombolitičnega zdravljenja pacientov z akutno možgansko kapjo, ga analizirati in pokazati več variant možnih izboljšav ter z validacijo že obstoječega procesa predlagati najboljše tehnološke in organizacijske rešitve za prenovo le-tega.
Metode: V teoretičnem delu naloge smo uporabili deskriptivno metodo dela z zbiranjem in analizo domače in tuje literature, s pomočjo katere smo opisali teoretična izhodišča. V aplikativnem delu raziskave smo uporabili kvalitativno metodologijo dela, kjer smo podatke zbrali z uporabo deskriptivne metode dela in analizo obstoječih dokumentov, katere smo pridobili na nevrološkem oddelku.
Rezultati: S procesnim pristopom smo kritično analizirali operativne procese, jih časovno ovrednotili in izključili procesne korake, pri katerih nastajajo zamude. Tako smo zmanjšali pričakovani čas procesa na 38 minut, če prihaja pacient v urgentni center sam ali s svojci, in na 25 minut, če pacienta pripeljejo reševalci in urgentni zdravnik.
Razprava : Pripravili smo popis vseh operativnih procesov in jih časovno opredelili. Izračunali smo pričakovane čase procesa trombolitičnega zdravljenja. Ugotovili smo, kje nastajajo zamude. Tako smo lahko izključili procesne korake, pri katerih nastajajo zamude, ter pripravili predlog prenove procesa, s katerim smo dosegli »door to needle time« (DNT) pod 60 minut. Pri magistrski nalogi smo naredili predlog prenove trombolitičnega procesa v eni od Splošni bolnišnici osrednje vzhodne Slovenije, katerega bi bilo potrebno pred samo implementacijo še verificirati s kliničnega vidika.
Keywords: proces, prenova procesa, možganska kap, trombolitično zdravljenje, DNT.
Published in DKUM: 19.11.2021; Views: 828; Downloads: 94
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