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BACKGROUND: Histiocytoses are rare disorders characterized by the accumulation of macrophages, dendritic cells, or monocyte-derived cells in various tissues and organs of children and adults, with a wide range of clinical manifestations, presentations, and histology. The histiocytoses are classified according to the WHO Classification, the last version of which was published in 2022, or according to the Histiocyte Society Classification, with the last version published in 2016. PURPOSE: This text provides an overview of histiocytoses as described in the WHO Classification 2022.
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Organización Mundial de la Salud , Humanos , Histiocitosis/patología , Histiocitosis/clasificación , Histiocitosis/diagnóstico , Neoplasias Hematológicas/clasificación , Neoplasias Hematológicas/patología , Células Dendríticas/patologíaRESUMEN
OBJECTIVES: Although there is well-established evidence for the existence of socio-economic inequalities in virtually all dimensions of health, little is known about the implications of these socio-economic disparities for healthcare costs from a cumulative life course perspective. Accounting for differentials in healthcare use patterns and mortality, we assess how lifetime costs differ between socio-economic groups. STUDY DESIGN: This study used dynamic microsimulation modelling. METHODS: Combining price weights for healthcare services with information on healthcare consumption from the 2014 Austrian Health Interview Survey (n = 15,771), we calculated average cost profiles by gender, age and education consistent with aggregate System of Health Accounts. A dynamic microsimulation model was used to project cumulative healthcare costs over the entire lifecycle for the 2019 birth cohort in four different scenarios to illustrate the influence of the different cost determinants on lifetime costs. RESULTS: Before considering social inequalities in mortality, men with compulsory education have close to 66% higher lifetime costs than men with tertiary education; for women, the difference is close to 20%. Accounting for longevity differentials reduces this gap to approximately 40% for men and 10% for women. Closing the gap in healthcare use and in longevity between socio-economic groups would reduce lifetime healthcare expenditure by 4.1% in the 2019 birth cohort and by 19% in the whole population. CONCLUSIONS: Accounting for mortality differentials between socio-economic groups has a large impact on estimated lifetime healthcare costs. Reducing social inequalities in health can contribute to containing healthcare expenditures against the backdrop of rising life expectancy.
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Costos de la Atención en Salud , Acontecimientos que Cambian la Vida , Masculino , Humanos , Femenino , Factores Socioeconómicos , Escolaridad , Gastos en SaludRESUMEN
BACKGROUND: Idiopathic multicentric Castleman disease (iMCD) is characterized by constitutional symptoms, enlarged lymph nodes and laboratory test abnormalities, which are primarily related to the overproduction of interleukin-6 (IL-6). This form (iMCD) was treated earlier with cytostatics used for lymphoma, later with bio-logic therapy as rituximab, immunodulatory drugs and proteasome inhibitors, and in the last years with an anti-IL-6 antibody, siltuximab. Siltuximab is a human-mouse chimeric immunoglobulin G1k monoclonal antibody against human IL-6 approved in the European Union for the treatment of iMCD. In view of the limited treatment options for iMCD, this case report aimed to evaluate the efficacy and safety of siltuximab in the management of this condition. CASE: We describe a young woman with iMCD diagnosed at the age of 25 years. For first line treatment, rituximab and dexamethasone were used without any cytostatic because the patient wished to give birth to a healthy child in the future. However, the response after this first line therapy was short. In addition, after 3 years from the start of rituximab + dexamethasone therapy, it was necessary to administer treatment for the relapse of iMCD. We decided for siltuximab in this young woman, still aged < 30 years, and started administration of siltuximab in 3-week intervals. RESULTS: After administration of first two infusions of siltuximab, all inflammatory markers returned to normal value. Moreover, serum hemoglobin and albumin levels as well as C-reactive protein normalized after the first two administrations of siltuximab. The clinical response continue, siltuximab is still administered in 3-week intervals. PET/CT with fluorodeoxyglucose confirmed a very good anatomic and metabolic response to the treatment. Siltuximab demonstrated a favorable safety profile, and the prolonged treatment was well tolerated. CONCLUSION: This result is encouraging and demonstrates the potential of siltuximab as treatment of CD. As earlier published, this case confirms that significantly elevated inflammatory markers in a patient with CD predict a good response to siltuximab.
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Enfermedad de Castleman , Citostáticos , Femenino , Humanos , Anticuerpos Monoclonales/uso terapéutico , Enfermedad de Castleman/tratamiento farmacológico , Dexametasona , Inmunosupresores , Interleucina-6 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Rituximab/uso terapéutico , AdultoRESUMEN
OBJECTIVE/BACKGROUND: The benefit of Continuous Positive Airway Pressure (CPAP) treatment following ischemic stroke in patients with obstructive sleep-disordered breathing (SDB) is unclear. We set out to investigate this open question in a randomized controlled trial as part of the SAS-CARE study. PATIENTS/METHODS: Non-sleepy patients (ESS < 10) with ischemic stroke or transient ischemic attack (TIA) and obstructive SDB (AHI ≥ 20) 3 months post-stroke were randomized 1:1 to CPAP treatment (CPAP+) or standard care. Primary outcome was the occurrence of vascular events (TIA/stroke, myocardial infarction/revascularization, hospitalization for heart failure or unstable angina) or death within 24 months post-stroke. Secondary outcomes included Modified Rankin Scale (mRS) and Barthel Index. RESULTS: Among 238 SAS-CARE patients 41 (17%) non-sleepy obstructive SDB patients were randomized to CPAP (n = 19) or standard care (n = 22). Most patients (80%) had stroke and were males (78%), mean age was 64 ± 7 years and mean NIHSS score 0.6 ± 1.0 (range: 0-5). The primary endpoint was met by one patient in the standard care arm (a new stroke). In an intent-to treat analysis disregarding adherence, this corresponds to an absolute risk difference of 4.5% or an NNT = 22. mRS and Barthel Index were stable and similar between arms. CPAP adherence was sufficient in 60% of evaluable patients at month 24. CONCLUSION: No benefit of CPAP started three months post-stroke was found in terms of new cardio- and cerebrovascular events over 2 years. This may be related to the small size of this study, the mild stoke severity, the exclusion of sleepy patients, the delayed start of treatment, and the overall low event rate.
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Hearing and its protection is regulated by ATP-evoked Ca(2+) signaling in the supporting cells of the organ of Corti, however, the unique anatomy of the cochlea hampers observing these mechanisms. For the first time, we have performed functional ratiometric Ca(2+) imaging (fura-2) in three different supporting cell types in the hemicochlea preparation of hearing mice to measure purinergic receptor-mediated Ca(2+) signaling in pillar, Deiters' and Hensen's cells. Their resting [Ca(2+)]i was determined and compared in the same type of preparation. ATP evoked reversible, repeatable and dose-dependent Ca(2+) transients in all three cell types, showing desensitization. Inhibiting the Ca(2+) signaling of the ionotropic P2X (omission of extracellular Ca(2+)) and metabotropic P2Y purinergic receptors (depletion of intracellular Ca(2+) stores) revealed the involvement of both receptor types. Detection of P2X2,3,4,6,7 and P2Y1,2,6,12,14 receptor mRNAs by RT-PCR supported this finding and antagonism by PPADS suggested different functional purinergic receptor population in pillar versus Deiters' and Hensen's cells. The sum of the extra- and intracellular Ca(2+)-dependent components of the response was about equal with the control ATP response (linear additivity) in pillar cells, and showed supralinearity in Deiters' and Hensen's cells. Calcium-induced calcium release might explain this synergistic interaction. The more pronounced Ca(2+) leak from the endoplasmic reticulum in Deiters' and Hensen's cells, unmasked by cyclopiazonic acid, may also suggests the higher activity of the internal stores in Ca(2+) signaling in these cells. Differences in Ca(2+) homeostasis and ATP-induced Ca(2+) signaling might reflect the distinct roles these cells play in cochlear function and pathophysiology.
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Adenosina Trifosfato/fisiología , Señalización del Calcio/fisiología , Cóclea/fisiología , Animales , Cóclea/citología , Potenciales Evocados Auditivos , Ratones , ARN Mensajero/genética , Receptores Purinérgicos P2X/genética , Receptores Purinérgicos P2Y/genéticaRESUMEN
The brain receives and integrates environmental and metabolic information, transforms these signals into adequate neuronal circuit activities, and generates physiological behaviors to promote energy homeostasis. The responsible neuronal circuitries show lifetime plasticity and guaranty metabolic health and survival. However, this highly evolved organization has become challenged nowadays by chronic overload with nutrients and reduced physical activity, which results in an ever-increasing number of obese individuals worldwide. Research within the last two decades has aimed to decipher the responsible molecular and cellular mechanisms for regulation of the hypothalamic melanocortin neurons, which have a key role in the control of food intake and energy metabolism. This review maps the central connections of the melanocortin system and highlights its global position and divergent character in physiological and pathological metabolic events. Moreover, recently uncovered molecular and cellular processes in hypothalamic neurons and glial cells that drive plastic morphological and physiological changes in these cells, and account for regulation of food intake and energy metabolism, are brought into focus. Finally, potential functional interactions between metabolic disorders and psychiatric diseases are discussed.
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Ingestión de Alimentos/fisiología , Metabolismo Energético/fisiología , Hipotálamo/fisiología , Melanocortinas/fisiología , Proopiomelanocortina/fisiología , Proteína Relacionada con Agouti/fisiología , Animales , Humanos , Hipotálamo/fisiopatología , Trastornos Mentales/fisiopatología , Modelos Neurológicos , Neuroglía/fisiología , Neuronas/fisiología , Neuropéptido Y/fisiología , Orgánulos/fisiologíaRESUMEN
OBJECTIVES: Adherence is critical for maximizing the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection. Strategies for promoting adherence to HIV treatment, and their potential application to PrEP adherence, have received considerable attention. However, adherence promotion strategies for prevention medications have not been well characterized and may be more applicable to PrEP. We aimed to identify adherence support interventions that have been effective in other prevention fields and could be applied in the HIV prevention context to support pill taking among PrEP users. METHODS: To identify adherence support interventions that could be evaluated and applied in the PrEP context, we conducted a systematic review across the following prevention fields: hypertension, latent tuberculosis infection, hyperlipidaemia, oral contraceptives, osteoporosis, malaria prophylaxis, and post-exposure prophylaxis for HIV infection. We included randomized controlled trials that evaluated the efficacy of interventions to improve adherence to daily oral medications prescribed for primary prevention in healthy individuals or for secondary prevention in asymptomatic individuals. RESULTS: Our searches identified 585 studies, of which 48 studies met the eligibility criteria and were included in the review; nine evaluated multiple strategies, yielding 64 separately tested interventions. Interventions with the strongest evidence for improving adherence included complex, resource-intensive interventions, which combined multiple adherence support approaches, and low-cost, low-intensity interventions that provided education or telephone calls for adherence support. CONCLUSIONS: Our review identified adherence interventions with strong evidence of efficacy across prevention fields and provides recommendations for evaluating these interventions in upcoming PrEP studies.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Cumplimiento de la Medicación , Prevención Primaria , Promoción de la Salud/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Sensorineural hearing losses (SNHLs; e.g., ototoxicant- and noise-induced hearing loss or presbycusis) are among the most frequent sensory deficits, but they lack effective drug therapies. The majority of recent therapeutic approaches focused on the trials of antioxidants and reactive oxygen species (ROS) scavengers in SNHLs. The rationale for these studies was the prominent role of disturbed redox homeostasis and the consequent ROS elevation. Although the antioxidant therapies in several animal studies seemed to be promising, clinical trials have failed to fulfill expectations. We investigated the potential of rasagiline, an FDA-approved monomanine oxidase type B inhibitor (MAO-B) inhibitor type anti-parkinsonian drug, as an otoprotectant. We showed a dose-dependent alleviation of the kanamycin-induced threshold shifts measured by auditory brainstem response (ABR) in an ototoxicant aminoglycoside antibiotic-based hearing loss model in mice. This effect proved to be statistically significant at a 6-mg/kg (s.c.) dose. The most prominent effect appeared at 16kHz, which is the hearing sensitivity optimum for mice. The neuroprotective, antiapoptotic and antioxidant effects of rasagiline in animal models, all targeting a specific mechanism of aminoglycoside injury, may explain this otoprotection. The dopaminergic neurotransmission enhancer effect of rasagiline might also contribute to the protection. Dopamine (DA), released from lateral olivocochlear (LOC) fibers, was shown to exert a protective action against excitotoxicity, a pathological factor in the aminoglycoside-induced SNHL. We have shown that rasagiline enhanced the electric stimulation-evoked release of DA from an acute mouse cochlea preparation in a dose-dependent manner. Using inhibitors of voltage-gated Na(+)-, Ca(2+) channels and DA transporters, we revealed that rasagiline potentiated the action potential-evoked release of DA by inhibiting the reuptake. The complex, multifactorial pathomechanism of SNHLs most likely requires drugs acting on multiple targets for effective therapy. Rasagiline, with its multi-target action and favorable adverse effects profile, might be a good candidate for a clinical trial testing the otoprotective indication.
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Pérdida Auditiva Sensorineural/tratamiento farmacológico , Indanos/uso terapéutico , Inhibidores de la Monoaminooxidasa/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Animales , Antibacterianos/toxicidad , Cóclea/efectos de los fármacos , Dopamina/análisis , Pérdida Auditiva Sensorineural/inducido químicamente , Kanamicina/toxicidad , Masculino , Ratones , Ratones Endogámicos BALB CRESUMEN
The aim of our study was to investigate changes in psycho-physiological parameters evoked by short duration, intensive physical stress on university students practicing judo at different intensities and timely manner. Stability of posture, muscle strength (hand force exertions), attention concentration (choice reaction time), cardiac parameters, (ECG, heart rate, heart rate variability), and oxygen saturation were measured, cardiac state and stress index were computed before and after the physical stress. The actual psychic state of the subjects was evaluated using the Spielberger's STPI-H Y-1 test which determined anxiety, curiosity, anger and depression level. Analysis of psychometric and physiologic parameters indicated significant correlations, among others, between force and cardiac stress (-), force and depression (-), anxiety and errors in actions (+), cardiac state and errors in action (-), cardiac state and depression (-). Paired samples tests showed the influence of intensive physical stress within groups of students, and independent samples tests made it possible to evaluate the power of medical and sport students, performing physical training at a significantly higher level than it is usual among the medical students. Our results proved that higher level physical training influences the psychic state advantageously, limits increases in cardiac stress level, and decreases susceptibility to anxiety and depression.
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Adaptación Psicológica/fisiología , Ansiedad/fisiopatología , Depresión/fisiopatología , Actividad Motora/fisiología , Estrés Fisiológico/fisiología , Adolescente , Femenino , Corazón/fisiología , Humanos , Masculino , Fuerza Muscular/fisiología , Psicofisiología , Tiempo de Reacción/fisiología , Adulto JovenRESUMEN
Women with gestational diabetes mellitus (GDM) are at high risk of subsequently developing type 2 diabetes mellitus which is an important cardiovascular risk factor. We have evaluated whether preclinical morphological and functional arterial changes are present in GDM. Diameter, intima-media thickness (IMT), intima-media cross-section area (IMCSA) and elasticity features (compliance, distensibility coefficient, circumferential strain, stiffness index (SI) α and ß, incremental elastic modulus) of the common carotid arteries (CCA) were studied in the 3rd trimester in 25 women with GDM, and 17 normal pregnant women matched for age and body mass index using an ultrasonographic vessel wall-movement tracking system and applanation tonometry. Mean IMT, IMCSA and SI α tended to be larger, whereas compliance was smaller in women with GDM but none of these differences were significant. Serum glucose (4.99 ± 0.51 vs. 4.79 ± 0.61 mmol/L, p=0.37) and HbA1c (5.33 ± 0.27 vs. 5.36 ± 0.47 mmol/L, p=0.85) proved normoglycemia in both groups. In conclusion, by the combination of methods we applied in this case control study, neither morphological nor functional characteristics of large elastic arteries differ significantly between well-treated normoglycemic women with GDM and non-diabetic pregnant women in the 3rd trimester.
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Arteria Carótida Común/patología , Arteria Carótida Común/fisiopatología , Diabetes Gestacional/patología , Diabetes Gestacional/fisiopatología , Adulto , Análisis de Varianza , Biomarcadores/sangre , Fenómenos Biomecánicos , Glucemia/metabolismo , Presión Sanguínea , Arteria Carótida Común/diagnóstico por imagen , Estudios de Casos y Controles , Adaptabilidad , Diabetes Gestacional/sangre , Diabetes Gestacional/diagnóstico por imagen , Diabetes Gestacional/terapia , Módulo de Elasticidad , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Hungría , Manometría , Embarazo , Tercer Trimestre del Embarazo , Flujo Pulsátil , Túnica Íntima/patología , Túnica Media/patología , UltrasonografíaRESUMEN
Ghrelin, an orexigenic hormone produced by the stomach, increases food intake and enhances the locomotor and rewarding effects of cocaine. Consistent with these behavioral effects, ghrelin increases dopamine cell activity in the mesolimbic system resulting in elevated levels of dopamine release and turnover in target regions such as the ventral striatum. In the current study, we examined the psychostimulant effects of acute and daily cocaine in mice with targeted deletion of the ghrelin gene (ghrelin knockout; KO) and that of their wild-type (WT) littermates. We hypothesized that ghrelin-KO mice would be hyporesponsive to the effects of cocaine as reflected in attenuated locomotor activity following both acute and chronic injections, and that this would be correlated with striatal dopamine and dopamine metabolite concentrations. Results show that the locomotor stimulating effect of cocaine (10 mg/kg) was decreased in ghrelin-KO mice as compared with their WT littermates. In addition, repeated daily injection of cocaine resulted in gradual increases in locomotor activity in WT mice, an effect that was attenuated in ghrelin-KO mice. These behavioral effects were correlated with changes in dopamine utilization in the striatum of WT mice that were not seen in ghrelin-KO mice unless these were pretreated with ghrelin. These data suggest that ghrelin is important for normal function of the mesolimbic dopaminergic system, potentially modulating both dopamine release and reuptake.
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Cocaína/farmacología , Inhibidores de Captación de Dopamina/farmacología , Ghrelina/metabolismo , Actividad Motora/efectos de los fármacos , Animales , Dopamina/metabolismo , Ghrelina/deficiencia , Ratones , Ratones Endogámicos C57BL , Ratones Endogámicos DBA , Ratones NoqueadosRESUMEN
AIMS: Cardiovascular autonomic function is often assessed in patients with diabetes by measuring heart rate variability and baroreflex sensitivity, the heritability of which is not fully understood. The present study was aimed to determine the effects of genetic and environmental factors on heart rate variability and baroreflex sensitivity in monozygotic and dizygotic adult healthy twin pairs. METHODS: A total of 101 (63 monozygotic, 38 dizygotic) adult twin pairs (n = 202; mean age 44.3 years) were investigated. Anthropometric variables and serum metabolic markers were measured, while environmental characteristics were evaluated by questionnaires. Linear and spectral indices of heart rate variability and baroreflex sensitivity were determined by non-invasive methods. All measurements were adjusted for age and gender (model 1) and for all significantly relevant covariates (model 2). Heritability A-C-E structural equation models were used for characterizing the proportion of additive genetic, shared and unshared environmental influences. RESULTS: Genetic influence of different cardiovascular autonomic indices was estimated between 10.3 and 39.4%, common environmental influence was found between 0.0 and 33.2%, while unshared environmental influence was observed between 60.6 and 81.4% in model 1 analysis. In multivariable-adjusted heritability estimates (model 2), the magnitude of the genetic effects decreased to 0.0%, common environmental influence was nearly unchanged (values between 4.4 and 14.5%), while unshared environmental influence slightly increased (values between 85.5 and 96.5%). CONCLUSIONS: Unshared environmental but not genetic factors have substantial influence on cardiovascular autonomic function, suggesting that appropriate treatment of all modifiable environmental factors is of importance in order to prevent or ameliorate cardiovascular autonomic neuropathy.
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Glucemia/genética , Presión Sanguínea/genética , Enfermedades Cardiovasculares/genética , Sistema Cardiovascular/fisiopatología , Gemelos Dicigóticos/genética , Gemelos Monocigóticos/genética , Circunferencia de la Cintura/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/fisiopatología , Ayuno , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Maintenance of reduced body weight in lean and obese human subjects results in the persistent decrease in energy expenditure below what can be accounted for by changes in body mass and composition. Genetic and developmental factors may determine a central nervous system (CNS)-mediated minimum threshold of somatic energy stores below which behavioral and metabolic compensations for weight loss are invoked. A critical question is whether this threshold can be altered by environmental influences and by what mechanisms such alterations might be achieved. We examined the bioenergetic, behavioral, and CNS structural responses to weight reduction of diet-induced obese (DIO) and never-obese (CON) C57BL/6J male mice. We found that weight-reduced (WR) DIO-WR and CON-WR animals showed reductions in energy expenditure, adjusted for body mass and composition, comparable (-10-15%) to those seen in human subjects. The proportion of excitatory synapses on arcuate nucleus proopiomelanocortin neurons was decreased by â¼50% in both DIO-WR and CON-WR mice. These data suggest that prolonged maintenance of an elevated body weight (fat) alters energy homeostatic systems to defend a higher level of body fat. The synaptic changes could provide a neural substrate for the disproportionate decline in energy expenditure in weight-reduced individuals. This response to chronic weight elevation may also occur in humans. The mouse model described here could help to identify the molecular/cellular mechanisms underlying both the defense mechanisms against sustained weight loss and the upward resetting of those mechanisms following sustained weight gain.
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Peso Corporal/fisiología , Encéfalo/anatomía & histología , Metabolismo Energético/fisiología , Homeostasis/fisiología , Aumento de Peso/fisiología , Pérdida de Peso/fisiología , Animales , Núcleo Arqueado del Hipotálamo/anatomía & histología , Núcleo Arqueado del Hipotálamo/citología , Núcleo Arqueado del Hipotálamo/fisiología , Composición Corporal/fisiología , Peso Corporal/efectos de los fármacos , Encéfalo/fisiología , Restricción Calórica , Grasas de la Dieta/farmacología , Masculino , Ratones , Ratones Endogámicos C57BL , Modelos Animales , Neuronas/citología , Neuronas/fisiología , Sinapsis/fisiologíaRESUMEN
According database of Globocan 2008 of total 482 thousand worldwide new esophagel cancers are reported 16.9% cases in more developed and 83.1% in less developed regions, 6.9% in EU, 2.7% in the Eastern Europe; of total 989 thousand new stomach cancers are reported 27.8% in more developed and 72.2% in less developed regions, 8.4% in EU, 7.4% in the Eastern Europe; of total 1.235 milion new colorectal cancers are reported 59% cases in more developed and 41% in less developed regions, 27% in EU, 10.5% in the Eastern Europe. Of total 59,052 all neoplasms (without skin cancers) were reported 10,439 new cases of these three diagnoses in recent Czech Cancer Registry survey, higher by 595 cases than numbers based in Globocan 2008. However, according to these data the Czech males reached the 3rd order and females the 14th order by their cumulative risk of colorectal cancer in the world. The alarming worldwide numbers of new 4.771 milion of these three diagnoses and 3,137 thousands deaths from them, expected in 2030 with a higher risk in population of less developed regions require greater international cooperation and personal responsibility for improving the life-style, which would be failed the expected statistics.