In the course of Parkinson's disease, advanced and late stages can be distinguished. In the advanced stage, levodopa has good effect on motor symptoms, but patient care is often hindered by ...levodopa-induced complications such as motor fluctuation and dyskinesias. In the late stage levodopa response becomes poor, falls, dementia and psychotic symptoms appear and patients often need hospitalization. In the advanced stage, the quality of life may be improved better by device-aided therapy than by best oral medical treatment. The alternatives are apomorhin pump, levodopa carbidopa intestinal gel with pump and deep brain stimulation. The therapy plan should be based on the principle: "the right treatment, to the right patient, at the right time".
Abstract Introduction A different innervation pattern of proximal and distal muscles from the contra- and ipsilateral motor circuits raises the question as to whether bilateral, contra- and ...ipsilateral subthalamic stimulation may have different effects on the distal and proximal movements of the upper limb. To answer this question, we performed kinematic analyzes in patients with Parkinson's disease. Methods Twenty-eight Parkinsonian patients treated by bilateral subthalamic stimulation were examined with an age-matched control group of 28 healthy subjects. They performed 14 seconds of finger tapping, hand grasping and pronation-supination. The patient group performed these sessions in four conditions (BOTH ON, BOTH OFF, CONTRA ON, IPSI ON) after withdrawal of dopaminergic medication for 12 hours and a fifth condition after taking medication (BOTH ON-MED ON). A motion sensor with a three-dimensional gyroscope was worn on the index finger. Speed, amplitude, rhythm and decrement of movements were calculated and compared across these conditions. Results Speed and amplitude of the more distal movements were improved similarly by contra- and bilateral stimulation. Bilateral stimulation was more effective than contralateral stimulation for the more proximal movements. Contra- and bilateral stimulation ameliorated the rhythm similarly in each movement task. Decrement of distal and proximal movements was not affected by the stimulation conditions. Conclusion This is the first study to show that the outcome of bi- and unilateral subthalamic stimulation on proximal and distal upper limb movements should be evaluated separately postulating the different somatotopic organization of subloops in the cortico-basal ganglia motor circuits.
In advanced Parkinson's disease, medically refractory motor fluctuation or medically resistant tremor considerably affects quality of life. However, these symptoms can be mostly successfully treated ...by deep brain stimulation. We analyzed the efficacy of bilateral subthalamic stimulation in our patients with Parkinson's disease.
We assessed the clinical data of ten patients who have been treated in the Department of Neurology, Semmelweis University and have been operated in the National Institute of Neurosciences between 2008 and 2011. The Hoehn-Yahr scale score, the Unified Parkinson's Disease Rating Scale score and the Parkinson's Disease Questionnaire 39, as well as the dose of antiparkinson medication were documented prior to and one year after surgery.
Patient condition improved according to the Hoehn-Yahr scale, approximately by two stages. The dose of antiparkinson medication could be reduced by 63.4% (p = 0.005) post operation. Unified Parkinson's Disease Rating Scale scores decreased by 70.9% (p = 0.005). 12 hours after medication withdrawal, execution of daily activity improved by 57.1% (p < 0.01) and motor functions developed by 79.1% (p < 0.01). Duration of dyskinesias decreased by 62.5% (p = 0.018), duration of akinesia diminished by 87.5% (p = 0.005). Quality of life rose by 41.6% (p < 0.01). Neuropsychological tests detected improvement in verbal memory.
With deep brain stimulation, the dosage of antiparkinson medication could be significantly reduced, with considerable improvements in motor function and quality of life. Although the number of patients is still low, good results have been established by careful patient selection, precise neurosurgical procedure and by appropriate programming and patient care.
Background
Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass ...with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG.
Methods
Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena.
Results
Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (
t
(13.958) = − 2.373;
p
= 0.00;
p
< 0.05) and Low Positive Emotions (
t
(13.301) = − 2.954;
p
= 0.00;
p
< 0.05) and Introversion/Low Positive Emotionality (
t
(13.408) = − 1.914;
p
= 0.02;
p
< 0.05) in MMPI-2 data.
Conclusion
According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.
Összefoglaló. A landiolol intravénásan alkalmazandó, kifejezetten cardioselectiv, gyors hatású és rövid felezési idejű béta-1-receptor-blokkoló, mely elsősorban negatív chronotrop és inotrop hatással ...bír, vérnyomáscsökkentő hatása elhanyagolható. Főleg hemodinamikailag instabil állapotú, supraventricularis ritmuszavarban szenvedő betegek kamrafrekvenciájának csökkentésére használható. Nagy esetszámú, randomizált vizsgálatok igazolták hatékonyságát szívműtétek után jelentkező pitvarfibrilláció megelőzésében, valamint súlyos akut szívelégtelenségben és szívműtétek posztoperatív szakában jelentkező pitvari tachyarrhythmiák kezelésében. Ezek mellett kisebb vizsgálatok alapján a használata biztonságosnak tűnik akut myocardialis infarctusban, hatékony szeptikus állapotú, pitvarfibrillációban szenvedő betegek kamrafrekvencia- és ritmuskontrolljára, valamint nem cardialis műtétek esetén a pitvarfibrilláció prevenciójára és kezelésére. Sikerrel alkalmazható elektromos vihar esetén is, és jól használható angiográfiás coronaria-CT-vizsgálat előtt az optimális szívfrekvencia elérésére. A gyógyszer 2016 óta Európában, 2018 óta Magyarországon is elérhető. Orv Hetil. 2022; 163(2): 53-62. Summary. Landiolol is an intravenous, selective beta-1-receptor blocking agent with rapid onset of action and ultra-short half-life that has a predominant negative chronotropic and only mild negative inotropic effect without significant reduction of blood pressure. Landiolol is indicated to control the ventricular heart rate predominantly in patients with hemodynamic instability due to supraventricular tachyarrhythmia. Large randomized controlled trials have proven the efficacy of landiolol in the prevention of atrial fibrillation and atrial tachyarrhythmias in severe acute heart failure or post-cardiac surgery. Based on lower case-number studies, the administration of landiolol has been proven to be efficient and safe in rhythm and rate control in atrial fibrillation complicating acute myocardial infarction, sepsis, and in the prevention of atrial fibrillation in non-cardiac surgery. Landiolol may be used in electrical storm, and even during coronary CT-angiography to achieve an optimal heart rate for imaging. The drug is available in Europe since 2016 and in Hungary since 2018. Orv Hetil. 2022; 163(2): 53-62.
We are living in a time of fundamental changes in the dynamic between privacy and surveillance. The ubiquity of information technology has changed the ways in which we interact, empowering us through ...new venues of communication and social intimacy. At the same time, it exposes us to the prying eyes of others, in the shape of governments, companies, or even fellow humans. This creates a challenging environment for the design of 'privacy-aware' applications, exacerbated by a disconnect between abstract knowledge of privacy and concrete information requirements of privacy design frameworks.;
;
In this work, we present a novel approach for the modeling of contextual privacy preference and practice. The process guides a 'privacy analyst' through the steps of evaluating, choosing, and deploying appropriate data collection strategies; the verification and validation of the collected data; and the systematic transformation of the dense, unstructured data into a structured domain model. We introduce the Privacy Domain Modeling Language (PDML) to address the representational needs of privacy domain models. Making use of the structure of PDML, we explore the applicability of the information theoretic concept 'entropy' to determine the completeness of the resulting model. We evaluate the utility of the process through its application to the evaluation and re-design of a web application for the management of students' directory information and education records. Through this case study, we demonstrate the potential for automation of the process through the Privacy Analyst Work eNvironment (PAWN) and show the process's seamless integration with existing privacy design frameworks. Finally, we provide evidence for the value of using entropy for determining model completeness, and provide an outlook on future work.
Ph. D.
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