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Abstract

Based on the current literature, the link between Achilles tendon moment arm length and running economy is not well understood. Therefore, the aim of this study was to further investigate the connection between Achilles tendon moment arm and running economy and the influence of Achilles tendon moment arm on the function of the plantarflexor muscle-tendon unit during running.

Ten male competitive marathon runners volunteered for this study. The participants ran on a treadmill at two running speeds: 3 and 3.5 m s−1. During running the oxygen consumption, lower leg kinematics, electrical activity of plantar flexor muscles, and fascicle behavior of the lateral gastrocnemius were measured simultaneously. On the second occasion, an MRI scan of the right leg was taken and used to estimate the Achilles tendon moment arm length.

There was a negative correlation between running economy and the body height normalized moment arm length at both selected speeds (r = −0.68, P = 0.014 and r = −0.70, P = 0.01). In addition, Achilles tendon moment arm length correlated with the amplitude of the ankle flexion at both speeds (r = −0.59, P = 0.03 and r = −0.60, P = 0.03) and with the electrical activity of the medial gastrocnemius muscle at 3 m s−1 speed (r = −0.62, P = 0.02). Our finding supports the concept that a longer moment arm could be beneficial for distance runners.

Open access

Abstract

In this study, the ability of microRNA-1906 (miR-1906) to attenuate bone loss in osteoporosis was evaluated by measuring the effects of a miR-1906 mimic and inhibitor on the cellular toxicity and cell viability of MC3T3‐E1 cells. Bone marrow-derived macrophage (BMM) cells were isolated from female mice, and tartrate-resistant acid phosphatase signalling was performed in miR-1906 mimic-treated, receptor-activated nuclear factor kappa-B (NF-κB) ligand (RANKL)-induced osteoclasts. In-vivo, osteoporosis was induced by ovariectomy (OVX). Rats were treated with 500 nmol/kg of the miR-1906 mimic via intrathecal administration for 10 consecutive days following surgery. The effect of the miR-1906 mimic on bone mineral density (BMD) in OVX rats was observed in the whole body, lumbar vertebrae and femur. Levels of biochemical parameters and cytokines in the serum of miR-1906 mimic-treated OVX rats were analysed. The mRNA expression of toll-like receptor 4 (TLR4), myeloid differentiation primary response 88 (MyD88), p-38 and NF-κB in tibias of osteoporotic rats (induced by ovariectomy) was observed using quantitative reverse-transcription polymerase chain reaction. Treatment with the miR-1906 mimic reduced cellular toxicity and enhanced the cell viability of MC3T3‐E1 cells. Furthermore, osteoclastogenesis in miR-1906 mimic-treated, RANKL-induced osteoclast cells was reduced, whereas the BMD in the miR-1906 mimic-treated group was higher than in the OVX group of rats. Treatment with the miR-1906 mimic also increased levels of biochemical parameters and cytokines in the serum of ovariectomised rats. Finally, mRNA expression levels of TLR4, MyD88, p-38 and NF-κB were lower in the tibias of miR-1906 mimic-treated rats than in those of OVX rats. In conclusion, the miR-1906 mimic reduces bone loss in rats with ovariectomy-induced osteoporosis by regulating the TLR4/MyD88/NF‐κB pathway.

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Abstract

After the first description of OXA-48 type carbapenemase, it has become endemic in Europe, Mediterranean and North African countries in a short time. OXA-48 carbapenemase is the most difficult type to determine and accurate diagnosis is crucial especially in endemic areas.

The CarbaNP test was described as a rapid phenotypic evaluation method of carbapenemases activity. Sensitivity and specifity of this test were high within all carbapenemases genes. In our study, we evaluated the efficacy of CarbaNP test in routine laboratories located in an endemic area of OXA-48 producing Enterobacterales.

A total of 53 Enterobacterales isolates were included in this study. Antimicrobial susceptibility of the isolates to imipenem, meropenem and ertapenem was determined. Polymerase Chain Reaction (PCR) was carried out for the detection of carbapenemases genes (bla KPC, bla NDM, bla BIC, bla IMP, bla VIM, bla SPM, bla AIM, bla DIM, bla GIM, bla SIM, and bla OXA-48). The Carba NP test was performed as in the protocol described previously.

Altogether 31 isolates (58.4%) were bla OXA-48 positive (18 Klebsiella pneumoniae, 8 Escherichia coli, 2 Serratia marcescens, 1 Enterobacter aerogenes, 1 Pantoea agglomerans and 1 Morganella morganii). Among these isolates 3 (5.6%) and 2 (3.7%) isolates were also positive for bla VIM and bla SPM, respectively.

The sensitivity and specifity of CarbaNP test were found 64.5, and 68.2% respectively. It was observed that determination of positive isolates is hard to distinguish and subjective.

The CarbaNP test has suboptimal results and low of sensitivity and specifity for detection of OXA-48 producing Enterobacterales, and not suitable for detection of bla OXA-48 positive isolates in routine laboratories in endemic areas.

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Acta Microbiologica et Immunologica Hungarica
Authors: Κonstantina Kontopoulou, Georgios Meletis, Styliani Pappa, Sofia Zotou, Katerina Tsioka, Panagiota Dimitriadou, Eleni Antoniadou, and Anna Papa

Abstract

Bacterial carbapenem resistance, especially when mediated by transferable carbapenemases, is of important public health concern. An increased number of metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae strains isolated in a tertiary hospital in Thessaloniki, Greece, called for further genetic investigation.

The study included 29 non-repetitive carbapenem resistant K. pneumoniae isolates phenotypically characterized as MBL-producers collected in a tertiary hospital in Greece. The isolates were screened for the detection of carbapenemase genes (K. pneumoniae carbapenemase (bla KPC), Verona-integron-encoded MBL-1 (bla VIM-1), imipenemase (bla IMP), oxacillinase-48 (bla OXA-48) and New Delhi MBL (bla NDM)). The genetic relationship of the isolates was determined by Random Amplified Polymorphic DNA (RAPD) analysis. The whole genome sequences (WGS) from two NDM-positive K. pneumoniae isolates were further characterized.

The presence of New Delhi MBL (bla NDM) gene was confirmed in all K. pneumoniae isolates, while bla KPC and bla VIM-1 genes were co-detected in one and two isolates, respectively. The RAPD analysis showed that the isolates were clustered into two groups. The whole genome sequence analysis of two K. pneumoniae isolates revealed that they belonged to the sequence type 11, they carried the bla NDM-1 gene, and exhibited differences in the number and type of the plasmids and the resistant genes.

All MBL-producing K. pneumoniae isolates of the study harbored a bla NDM gene, while WGS analysis revealed genetic diversity in resistance genes. Continuous surveillance is needed to detect the emergence of new clones in a hospital setting, while application of antimicrobial stewardship is the only way to reduce the spread of multi-resistant bacteria.

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Abstract

Bartonella henselae is the causative agent of cat scratch disease (CSD). In this study, we aimed to investigate the clinical data of patients with suspicion of CSD and delineate current epidemiological features.

A total of 785 patients with suspected CSD were included in the study. B. henselae IgM antibody was determined by indirect fluorescent antibody (IFA) test using a commercial kit (Euroimmun, Germany). Sex, age, clinical pre-diagnosis and animal contact information of the patients were obtained from hospital electronic database records.

Seventy-eight (9.9%) of 785 samples were seropositive. Out of 78 patients, 46 with animal contact data were further analyzed. Of these patients, 56% were male, and 41% were under 18 years of age. Seropositivity was more commonly observed in fall and winter. The most common finding was lymphadenitis (63%). Thirty-five patients (76%) had a previous history of animal contact (cat/dog). Of the 46 seropositive patients, 78.3, 15.2, 4.4, and 2.1% had titers of 1:80, 1:160, 1:320, and 1:640, respectively.

Our study confirms that CSD is not rare in Turkey. Thus, it should always be considered in the differential diagnosis of patients presenting with lymphadenopathy in all age groups, particularly children. Questioning of cat exposure should never be neglected, especially in areas with intense population of stray cats, such as Istanbul.

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Abstract

In the present pilot study, we evaluated different supplemental therapies using autologous multipotent mesenchymal stromal cells (MMSCs) for the treatment of cranial cruciate ligament defects in dogs. We used tibial tuberosity advancement (TTA) and augmented it by supportive therapy with MMSCs in three patient groups. In the first patient group, the dogs were injected with MMSCs directly into the treated stifle one month after surgery. In the second group, MMSCs were delivered in a silk fibroin scaffold which was placed in the osteotomy gap during surgery. In the third group, MMSCs were first mixed with bone tissue and blood from the patient and delivered into the osteotomy gap during surgery. In the control group, patients underwent the TTA procedure but did not receive MMSC treatment. In the group of patients who received cells in the silk fibroin scaffold during surgery, the osteotomy gap did not heal, presumably due to the low absorption of silk fibroin. Patients who received MMSCs mixed with bone tissue and blood during surgery into the osteotomy gap recovered clinically faster and had better healing of the osteotomy gap than dogs from the other two treated groups and from the control group, as assessed by clinical examination and quantification of radiographs. In conclusion, dogs that received stem cells directly into the osteotomy gap (Group 3) recovered faster compared to dogs from Groups 1 (MMSCs injected into the joint one month after surgery), 2 (cells implanted into the osteotomy gap in a silk fibroin scaffold), and the control group that did not receive additional MMSCs treatment.

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Acta Microbiologica et Immunologica Hungarica
Authors: Joana Korablioviene, Mykolas Mauricas, Irena Dumalakiene, Saulius Caplinskas, Rita Viliene, Justinas Baleisis, Gintautas Vysniauskis, Joanna Chorostowska-Wynimko, Ginreta Magelinskiene, Pavel Korabliov, and Arunas Valiulis

Abstract

This study investigated BCG masking dependency on the species of Mycobacterium through the immune response to the mycobacterial region of deletion 1 (RD-1) associated growth affecting proteins (GEP).

To evaluate the effects of GEP, 8-week old female BALB/c mice were immunized with either the wild type Mycobacterium bovis (MBGEP) or the ATCC Mycobacterium avium subsp. avium (MAGEP) strain and then subjected to further exposure with Mycobacterium terrae or M. avium sub. avium. Mice immunized with MAGEP and those mice further exposed to M. avium subsp. avium had increased granulocytes (GRA) and monocytes to lymphocytes rate (MLR) compared to control mice. Immunization of mice with GEP induced an antibody response one month after primary immunization, as observed by cross-reactivity. Our findings suggest that MAGEP is related to a latent hypersensitivity reaction and an increased risk of mycobacterial infection susceptibility. According to the results of the present study, previous sensitization with NTM antigens results in varying immune reactions after contact with different NTM argued that masking phenomena may be dependent on the species of Mycobacterium.

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Orvosi Hetilap
Authors: Imre Rurik, Péter Apor, Mária Barna, István Barna, J. Róbert Bedros, Péter Kempler, Éva Martos, Elemér Mohos, Gábor Pavlik, Gyula †Pados, József Pucsok, Gábor Simonyi, and György Bíró

Összefoglaló. Az elhízás és következményes megbetegedései fontos népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek részéről nagy igény van egy viszonylag rövid, áttekinthető, naprakész gyakorlatias útmutatóra. A különböző orvosszakmai társaságokban tevékenykedő, évtizedes szakmai tapasztalatokkal rendelkező szerzők összefoglalják tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás kezelését lépcsőzetesen célszerű megkezdeni, előtte felmérve a beteg motivációját, általános állapotát, lehetőségeit. A szerzők leírják az energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás megtervezésével kapcsolatos alapvető szempontokat. Felsorolják a hazánkban elérhető gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi támogatás igényét. Az elhízás megelőzésében az élet első 1000 napjának táplálkozása, a későbbiekben a szülői minta a meghatározó. Sok kihasználatlan lehetősége van a háziorvosok, a lakóközösségek, az állami szervek koordinált együttműködésének, helyi kezdeményezéseknek. Az elhízás betegségként való meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az elhízottak ellátására szakosodott multidiszciplináris centrumok számának és kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323–335.

Summary. Obesity and related morbidities have a high public health impact in Hungary. The treatment is a challenge, but prevention seems more effective. General practitioners, other specialists and health care professionals who are treating obese persons require short, summarized, updated and practical guideline. Hungarian medical professionals of different scientific societies, having decennial practices, are summarizing their evidence-based knowledge. Obesity management requires step by step approach, evaluating previously the general health condition, motivation and options of the patients. The measurement of energy requirement, planning of diet and physical activities, available surgical methods and medications are described in detail with life style and mental support needed. The most important period in the prevention of obesity is the first 1000 days from conception. Other significant factors are the life style habits of the parents. Proper obesity prevention requires better coordination of primary health care, community and governmental activities. Obesity should be defined as morbidity, therefore stronger governmental support and more health-policy initiatives are needed, beside increasing number and developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323–335.

Open access

Összefoglaló. Bevezetés és célkitűzések: Az együttműködés, a csoportmunka életünk szinte minden területén képes növelni a hatékonyságot. A rákgyógyításban már évtizedek óta alkalmazott onkoteamek működését vizsgálva, annak egyértelmű célja az orvosi hatékonyság, az egymástól tanulás és a jogi védelem biztosítása. Jelenleg egy másik aspektust hangsúlyozva próbáljuk bemutatni a kooperatív munka működését, megvilágítva a kommunikációban részt vevők lehetőségeit és dilemmáit, illetve legfőképpen a pszichés támogató hatást. Módszer és eredmények: A Pécsi Tudományegyetem Klinikai Központjának Onkoterápiás Intézetében 12 éve működik a kétlépcsős onkoteamrendszer. Az onkoterápiás megbeszéléseken egyéves időszak alatt 21 orvos, több adminisztrátor, klinikai kutatási munkatárs, szakdolgozó, gyógyszerész és pszichológus vett részt, a résztvevők szakmai tapasztalata igen széles spektrumot fedett le. A megbeszélések során az egyes betegek onkológiai életútja került részletes diszkusszióra interaktív formában, végül a döntési részletek rögzítésre kerültek a központi informatikai rendszerben. Megfigyeléseink rávilágítottak a csapatmunka előnyeire, illetve a csoport által ellátott feladatok megosztó, kiegyensúlyozó, oktatást segítő hatásaira. Az orvosok által kitöltött kérdőívek pedig bizonyították, hogy a közvetlen munkatársak közötti szakmai megbeszélés, egyféle „Bálint-csoport” működésként a pszichés terhek megosztásában is szerepet játszhat. Következtetés: A rákgyógyítás területén az elmúlt évek során bekövetkezett gyors fejlődés, a fokozott elvárások, illetve az ezen a területen végzett, sokszor igen összetett és lelkileg is megterhelő szakmai munka kiemelten fontossá teszi a hatékony minőségbiztosítási módszerek és együttműködési formák alkalmazását, melyek segítségével lehetőség nyílik a szakmai eszmecseréken át a többirányú tudástranszferre és a kiégést megelőző csoportventilációra. Orv Hetil. 2021; 162(9): 344–351.

Summary. Introduction: The teamwork, the cooperation is always able to elevate effectiveness in every field of life. The tumor board meetings which are widely used in cancer treatment process in the last decades were originally established to warrant the medical, educational and legal quality assurance. Over these aspects, here we present the possibilities and dilemmas of the team work in the communication practices and most of all the psychological support of the participants. Method and results: The two-level oncotherapy tumor board system was introduced 12 years ago at the Institute of Oncotherapy, Clinical Center, University of Pécs. During a one-year long observation period, 21 physicians and several administrators, study coordinators, pharmacists, nurses and psychologists with different experiences participated in the oncotherapy tumor board discussions. In the meetings, the specific cancer histories of the patients were analyzed in an interactive form, and finally the detailed decisions were stored in the medical database system. Our observations proved the advantages, moreover, the task sharing, balancing and educational effects of the teamwork. The results obtained from the questionnaires filled out by the physicians proved that the direct conversation between department colleagues works like a case-discussing “Bálint-group” in taking the role of distributing of the psychological burden of the physicians. Conclusion: The immense advancements in cancer treatment during the last years, moreover, the increased expectations and the complex and mentally charging professional tasks all demand the establishment of more effective quality control and cooperation methods. Introducing these new methods, it would lead to more efficient professional discussions, knowledge transfer and burnout preventive group-related psychological ventilation. Orv Hetil. 2021; 162(9): 344–351.

Open access

Összefoglaló. A Bruton-féle tirozin-kinázt gátló ibrutinib és a B-sejtes lymphoma-2-t gátló venetoklax a krónikus lymphoid leukaemia (CLL) kezelésének egyre korábbi vonalában alkalmazható, és ezek mellett a progressziómentes túlélés növekedése figyelhető meg. A célzott kismolekulákkal végzett kezelés nemcsak a CLL lefolyását, de a betegek gondozását is alapvetően megváltoztatta. A tartósan adagolt orális szerek mellett a betegek nagyobb valószínűséggel jelennek meg a panaszaiknak megfelelő szakrendeléseken. Az új típusú szerek hatásai és mellékhatásai mellett az alapvető gyógyszer-interakciókra is fel kell hívni a figyelmet. Kiemelt fontosságú az ibrutinib hypertoniát provokáló hatása, illetve a 6–16%-ban megjelenő pitvarfibrilláció. Ez utóbbi ellátását a gyógyszer-interakciókon túl az ibrutinib vérzékenységet okozó hatása is nehezíti. A CLL-lel, illetve annak kezelésével kapcsolatos ismeretek a másodlagos daganatok, néhány gastrointestinalis és bőrgyógyászati betegség megközelítése szempontjából is fontosak. A venetoklax mellett potenciálisan kialakuló tumorlízis-szindróma alkalmanként a nefrológusok bevonását igényli. A betegek gondozása, megfelelő szakszerű ellátása és a betegutak optimalizálása érdekében a háziorvosok, a sürgősségi ellátók és az egyéb szakellátó helyek szoros együttműködése szükséges szakorvosi konzultáció keretei között. Orv Hetil. 2021; 162(9): 336–343.

Summary. Chronic lymphocytic leukemia (CLL) is ubiquitously treated with novel agents. The Bruton’s tyrosine kinase inhibitor ibrutinib and the B-cell lymphoma 2 inhibitor venetoclax can be used increasingly in earlier lines of treatment with improved progression-free survival. Treatment with targeted small molecules fundamentally changed not only the course of CLL but also the care of patients. With the administration of long-term oral medications, patients are more likely to show up at specialist clinics that match their complaints. In addition to the effects and side effects of the new drugs, attention should also be drawn to basic drug interactions. The effect of ibrutinib on blood pressure and the ability to provoke atrial fibrillation in 6–16% of cases are of paramount importance. In addition to drug interactions, the treatment of the latter is also complicated by the hemorrhagic effect of ibrutinib. Knowledge on CLL and its treatment is also important in the approach to secondary tumors, some gastrointestinal and dermatological diseases. The potential for tumor lysis syndrome of venetoclax requires close collaboration with nephrologists. In order to provide appropriate professional care and optimize patient pathways, close co-operation between GPs, emergency care providers and other specialist care facilities is required within the framework of professional consultation. Orv Hetil. 2021; 162(9): 336–343.

Open access