Disturbance Of Balance Research Articles

Chronic exposure to environmental concentrations of benzo[a]pyrene causes multifaceted toxic effects of developmental compromise, redox imbalance, and modulated transcriptional profiles in the early life stages of marine medaka (Oryzias melastigma)

Polycyclic aromatic hydrocarbons (PAHs) accumulate and integrate into aquatic environments, raising concerns about the well-being and safety of aquatic ecosystems. Benzo[a]pyrene (BaP), a persistent PAH commonly detected in the environment, has been extensively studied. However, the broader multifaceted toxicity potential of BaP on the early life stages of marine fish during chronic exposure to environmentally relevant concentrations needs further exploration. To fill these knowledge gaps, this study assessed the in vivo biotoxicity of BaP (1, 4, and 8 μg/L) in marine medaka (Oryzias melastigma) during early development over a 30-day exposure period. The investigation included morphological, biochemical, and molecular-level analyses to capture the broader potential of BaP toxicity. Morphological analyses showed that exposure to BaP resulted in skeletal curvatures, heart anomalies, growth retardation, elevated mortality, delayed and reduced hatching rates. Biochemical analyses revealed that BaP exposure not only created oxidative stress but also disrupted the activities of antioxidant enzymes. This disturbance in redox balance was further explored by molecular level investigation. The transcriptional profiles revealed impaired oxidative phosphorylation (OXPHOS) and tricarboxylic acid (TCA) cycle pathways, which potentially inhibited the oxidative respiratory chain in fish following exposure to BaP, and reduced the production of adenosine triphosphate (ATP) and succinate dehydrogenase (SDH). Furthermore, this investigation indicated a potential connection to apoptosis, as demonstrated by fluorescence microscopy and histological analyses, and supported by an increase in the expression levels of related genes via real-time quantitative PCR. This study enhances our understanding of the molecular-level impacts of BaP's multifaceted toxicity in the early life stages of marine medaka, and the associated risks.

COMPARATIVE ANALYSIS OF MECHANISMS OF ACTION OF PEPTIDE TOXINS, INHIBITORS OF CALCIUM AND SODIUM CHANNELS, UNDER ISCHEMIA/REPERFUSION

Ischemia contributes to many pathological conditions encountered in clinical practice. Besides, subsequent reperfusion may worsen tissue damage, exacerbating injuries caused by ischemia. Shifts in the balance of calcium and sodium ions play a major role in the development of ischemia-reperfusion injury. Inhibitors of calcium and sodium ion channels located on the membrane surface can help to avoid a sharp disturbance in the ion balance. Although such inhibitors reduce cell death, their mechanisms of action differ. The aim of the study is to conduct a comparative analysis of the mechanisms of action of peptide inhibitors of calcium and sodium channels on ischemia-reperfusion damage to epithelial cells. Materials and Methods. Peptide synthesizer was used for toxin synthesis. Chromatography and mass spectrometry were used for quality control. Analysis of cell death, changes in calcium and sodium ion concentrations, and pH levels were performed using fluorescent dyes and a multimodal reader. Results. It was found that peptide inhibitors of calcium and sodium channels reduce apoptosis and necrosis levels in CHO-K1 culture under simulated ischemia/reperfusion. The calcium channel inhibitor reduces cell death by lowering calcium and sodium ion concentrations and maintaining physiological pH levels throughout the reperfusion phase. The sodium channel inhibitor reduces death by lowering calcium and increasing sodium concentrations, and by maintaining an elevated pH throughout the reperfusion phase. Conclusion. Although both calcium and sodium concentrations as well as their mutual influence play an important role in the development of ischemia-reperfusion injury, inhibition of certain channels has different effects on intracellular processes with the same result, namely reduced cell death.

The role of miRNA-29b1 on the hypoxia-induced apoptosis in mammalian cardiomyocytes.

Cardiomyocyte apoptosis is a complex biological process involving the interaction of many factors and signaling pathways. In hypoxic environment, cardiomyocytes may trigger apoptosis due to insufficient energy supply, increased production of oxygen free radicals, and disturbance of intracellular calcium ion balance. The present research aimed to investigate the role of microRNA-29b1 (miR-29b1) in hypoxia-treated cardiomyocytes and its potential mechanism involved. We established an in vitro ischemia model using AC16 and H9C2 cardiomyocytes through hypoxia treatment (1% O2, 48 h). Cell apoptosis was evaluated by flow cytometry using Annexin V FITC-PI staining assay. Moreover, we used Western blot and immunofluorescence analysis to determine the expression of Bcl-2, Bax caspase-3 and Cx43 proteins. We found that miR-29b1 protected AC16 and H9C2 cells from hypoxia-induced injury as evidence that miR-29b1 attenuated the effects of hypoxia treatment on AC16 and H9C2 cell apoptosis after hypoxia treatment. In conclusion, our findings suggest that miR-29b1 may have potential cardiovascular protective effects during ischemia-related myocardial injury.

Comprehensive Evaluation of Sporadic Late-Onset Cerebellar Ataxias: Clinical Presentation, Diagnostic Challenges, and Treatment Outcomes.

Sporadic late-onset cerebellar ataxias (SLOCA) present a diagnostic challenge due to their heterogeneous etiologies and complex clinical manifestations. This retrospective study aimed to conduct a comprehensive evaluation of six male patients diagnosed with SLOCA, with a mean age of 55 years and an average symptom onset at 47 years. All patients presented with gait and balance disturbances, with additional sensory abnormalities observed in two cases. Neurological examinations revealed varied cerebellar syndromes, including static and static-kinetic presentations, accompanied by peripheral neurogenic syndromes in some instances. Brain MRI findings showed cerebellar atrophy, predominantly involving the vermis, in a subset of patients. Biochemical and serological investigations yielded mostly unremarkable results, although two patients exhibited significant vitamin E deficiency and anti-Hu antibodies (anti-neuronal nuclear antibody type 1). Electromyography confirmed sensory axonal neuropathy in those with peripheral neurogenic syndromes. Treatment with TOCO 500 mg (Vitamin E) was administered to four patients, with follow-up indicating stable disease progression in two cases. This study underscores the complexity of SLOCA and the need for a multidisciplinary approach to diagnosis and management. Further research is warranted to elucidate the underlying mechanisms and improve clinical outcomes for affected individuals.

The NR4A2/VGF pathway fuels inflammation-induced neurodegeneration via promoting neuronal glycolysis.

A disturbed balance between excitation and inhibition (E/I balance) is increasingly recognized as a key driver of neurodegeneration in multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system. To understand how chronic hyperexcitability contributes to neuronal loss in MS, we transcriptionally profiled neurons from mice lacking inhibitory metabotropic glutamate signaling with shifted E/I balance and increased vulnerability to inflammation-induced neurodegeneration. This revealed a prominent induction of the nuclear receptor NR4A2 in neurons. Mechanistically, NR4A2 increased susceptibility to excitotoxicity by stimulating continuous VGF secretion leading to glycolysis-dependent neuronal cell death. Extending these findings to people with MS (pwMS), we observed increased VGF levels in serum and brain biopsies. Notably, neuron-specific deletion of Vgf in a mouse model of MS ameliorated neurodegeneration. These findings underscore the detrimental effect of a persistent metabolic shift driven by excitatory activity as a fundamental mechanism in inflammation-induced neurodegeneration.

FDXR variants cause adrenal insufficiency and atypical sexual development.

Genetic defects affecting steroid biosynthesis cause cortisol deficiency and differences of sex development; among these defects are recessive mutations in the steroidogenic enzymes CYP11A1 and CYP11B, whose function is supported by reducing equivalents donated by ferredoxin reductase (FDXR) and ferredoxin. So far, mutations in the mitochondrial flavoprotein FDXR have been associated with a progressive neuropathic mitochondriopathy named FDXR-related mitochondriopathy (FRM), but cortisol insufficiency has not been documented. However, patients with FRM often experience worsening or demise following stress associated with infections. We investigated 2 female patients with FRM carrying the potentially novel homozygous FDXR mutation p.G437R with ambiguous genitalia at birth and sudden death in the first year of life; they presented with cortisol deficiency and androgen excess compatible with 11-hydroxylase deficiency. In addition, steroidogenic FDXR-variant cell lines reprogrammed from 3 patients with FRM fibroblasts displayed deficient mineralocorticoid and glucocorticoid production. Finally, Fdxr-mutant mice allelic to the severe p.R386W human variant showed reduced progesterone and corticosterone production. Therefore, our comprehensive studies show that human FDXR variants may cause compensated but possibly life-threatening adrenocortical insufficiency in stress by affecting adrenal glucocorticoid and mineralocorticoid synthesis through direct enzyme inhibition, most likely in combination with disturbed mitochondrial redox balance.

Exploring the link between occupationally relevant whole body vibration and headache and neck pain: is elevated muscle tension an intermediary factor?

Whole body vibration (WBV) is linked to short- and longer-term adverse health outcomes, including cognitive impairment, stress and memory loss, loss of balance, reduced proprioception, visual and vestibular disturbances, gastrointestinal problems, and musculoskeletal disorders. Epidemiological evidence supports the link between WBV and headache and head discomfort, but few experimental studies have examined this relationship, particularly with increased muscle tension, as an intermediary. This study aimed to investigate the relationship between muscle tension and vibration intensity, between perceived neck pain and headache/head discomfort and vibration intensity, and between muscle tension and reported neck pain and headache symptoms from simulated WBV based on field measurements of all-terrain vehicle operation on farm terrain. We observed significantly higher electromyography amplitude in the High condition (equivalent to EU Directive's Exposure Limit Value) compared to both Low (equivalent to EU Directive's Exposure Action Value) and Control (quiet sitting) conditions at the left upper trapezius muscle but there were no significant time effects. Neck pain and headache/head discomfort significantly increased after both Low (91% increase from baseline) and High (154% increase from baseline) vibration conditions but there were no significant differences between conditions. Based on simple regression modeling, the relationship between muscle activity and neck pain or headache was very weak (R2 = 0-0.093). Given the possibility of multiple factors contributing to headache symptoms, future research should not only consider the role of muscle tension but also sensory conflict, excessive noise, biodynamic responses, and a combination of these factors.

Mitochondrial Dysfunction, Its Oxidative Stress-Induced Pathologies and Redox Bioregulation through Low-Dose Medical Ozone: A Systematic Review.

Our hypothesis that controlled ozone applications interfere with the redox balance of a biological organism (first published in 1998 with a preclinical trial on protecting the liver from CCl4 intoxication) has been verified over the past two decades in reactive oxygen species (ROS)-induced mitochondrial pathologies, such as rheumatoid arthritis, osteoarthritis, aging processes and type 2 diabetes, and in the prevention of intoxications. Low-dose ozone acts as a redox bioregulator: the restoration of the disturbed redox balance is comprehensible in a number of preclinical and clinical studies by a remarkable increase in the antioxidant repair markers, here mainly shown as a glutathione increase and a reduction in oxidative stress markers, mainly malondialdehyde. The mechanism of action is shown, and relevant data are displayed, evaluated and comprehensively discussed: the repair side of the equilibrium increases by 21% up to 140% compared to the non-ozone-treated groups and depending on the indication, the stress markers are simultaneously reduced, and the redox system regains its balance.

Significance of Selected Posturographic Methods in Diagnosis of Balance Disorders in Patients with Early-Stage Gonarthrosis.

Degenerative joint disease is a dynamic pathological process characterised by a destabilisation of the degradation and synthesis processes of articular cartilage and subchondral bone layer. Studies suggest that individuals with gonarthrosis experience deficits in proprioception, in addition to changes within their joints, which directly affects their ability to maintain posture and increases their risk of falling. Objectives: The aim of this study was to assess the functional status of patients with gonarthrosis through a posturographic examination conducted on a stabilometric platform (force plate) and a functional clinical examination. Methods: Participants were divided into two groups-a control group (n = 125) and a study group (n = 125). During the qualification process, subjective and objective examinations were conducted, including a functional assessment by means of such tests as the "Up and Go" Test, Functional Reach Test, Five Time Sit to Stand Test, and the Step Test. Subsequently, an assessment was conducted on the force plate by means of a posturographic test-the Romberg test performed with open and closed eyes in a standing position-and balance was evaluated using the Berg Balance Scale. The obtained data were analysed with the use of the IBM SPSS Statistics software version 27.0, by means of the Mann-Whitney test, and correlations were determined by means of Spearman's test. A significance level of p = 0.05 was adopted. Results: Statistically significant differences were observed among the assessed groups as a result of both functional and posturographic examinations, along with positive correlations for disease duration, age, and BMI index. Conclusions: Patients with gonarthrosis exhibited disturbances in balance, functionality, and posture compared to healthy individuals in the control group.

Epigallocatechin-3-gallate-synthesized gold nanoparticles modulate reactive oxygen species and antioxidant parameters in brain and heart tissues using a chicken embryo model

Chemically synthesized gold nanoparticles (AuNPs) come with drawbacks, such as biological toxicity and ecological imbalances. Nonetheless, a knowledge gap remains regarding their impact on oxidative and antioxidant parameters. Here, environmentally friendly AuNPs were synthesized using epigallocatechin-3-gallate (AuNPs-EGCG). The successful synthesis of AuNPs-EGCG were confirmed using ultraviolet–visible spectroscopy, Fourier-transform infrared spectroscopy, atomic force microscopy, and dynamic light scattering. Antioxidant activity was assessed using free radical 2,2-diphenyl-1-picrylhydrazyl, oxygen radical absorbance capacity, and ferric reducing antioxidant power assays, while cytotoxicity properties were evaluated in the NIH3T3 fibroblast cells. Furthermore, the impact of AuNPs-EGCG on oxidative stress was investigated in the hearts and brains of chicken embryos. AuNPs-EGCG exhibited no cytotoxicity and was not toxic for chicken embryos at higher concentrations. However, exposure to lower concentrations (100 and 30 μg/mL) caused an increase in reactive oxygen species (ROS) levels and a decrease in total antioxidant capacity in the heart and brain, resulting in a disturbance in the redox balance attributed to a reduction in catalase activity and glutathione (GSH) content, and an increase in glutathione peroxidase activity. In contrast, AuNPs-EGCG at 300 μg/mL promoted an increase in GSH levels and modulation of ROS, while also reducing vascular density in the chorioallantoic membrane. Furthermore, AuNPs-EGCG did not cause lipid or protein oxidation. The present study offers evidence that supports the investigation of how AuNPs-EGCG can modulate antioxidant defense mechanisms and assess the safety of phytoantioxidant-functionalized nanoparticles in vivo. This may lead to new and innovative strategies for the utilization of nanomaterials in biological systems.

Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy.

Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy. A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The childrenwere dividedat random into three groups (14 in each group).In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediatelyafter four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis. The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement. The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.

The effects of MEPaL on oxidative stress and motor function in the rats affected by prenatal hypoxia

AbstractBackground and objectivesMaternal hypoxia disrupts neural development and subsequently leads to cerebral palsy and epilepsy in newborns. Hypoxia plays a role in neurodegeneration by increasing oxidative stress. Pistacia atlantica is known as an important antioxidant, and its anti‐inflammatory and antioxidant effects have been shown in various studies. This study aims to investigate the effects of methanolic extract of P. atlantica leaves (MEPaLs) on the oxidative parameters in the serum of rats affected by maternal hypoxia.Material and methodsIn this study, eight pregnant rats were used. The newborns were divided into four groups, including the control and the hypoxia groups, which are affected by maternal hypoxia, hypoxia + MEPaL 100 mg/kg, and hypoxia + MEPaL 150 mg/kg. MEPaL was injected (i.p) for 21 days into the neonatal rats after the lactation period. Hypoxia was induced by keeping pregnant rats in a hypoxic chamber with 7% oxygen and 93% nitrogen intensity for 3 h on the 20th day of pregnancy. Behavioral changes were measured using open‐field and rotarod tests. Finally, biomarkers of oxidative stress, nitric oxide (NO), glutathione (GSH), GSSG, TAS, TOS, and oxidative stress index (OSI) were measured in the experimental groups.ResultsBehavioral results showed that the anxiety behavior in the hypoxia group increased, but the motor activity (moved distance and movement speed) decreased. Moreover, the amount of time spent maintaining balance on the rotarod rod was significantly decreased in the hypoxia group. The concentration of NO in the group of hypoxia + MEPaL 100 mg/kg showed a significant decrease, and MEPaL 100, and 150 mg/kg + hypoxia also increased the concentration of GSH and decreased GSSG. In addition, MEPaL100 and 150 mg/kg caused a significant increase in the ratio of GSH to GSSG and decreased OSI and total oxidant capacity.ConclusionsOxidative stress increased in the rats affected by maternal hypoxia and may be the main mechanism for motor activity impairment and balance disturbance, whereas MELaL improved motor performance by decreasing oxidative stress.

Effect of Reproductive System Dysbiosis on the Course of Pregnancy

Abstract Genetic, endocrine and immunological disorders, anatomical defects in the reproductive tract, certain chronic diseases, toxic substances, or advanced age of the mother are most cited among the main causes of pregnancy loss at various stages. However, the cause of miscarriage or preterm labor in some cases remains unclear. Determination of the etiology about these clinical conditions may reduce the rate of reproductive failure. Similarly, the etiology of other obstetric disorders, such as preeclampsia or postpartum hemorrhage, has not been fully explained. One of the postulated and still under-researched causes of these disorders may be dysbiosis within the reproductive tract. A disturbed microbial balance is not always associated with the presence of an acute infection with clear clinical symptoms. Dysbiosis in conjunction with other pathophysiological factors may increase the risk of the mentioned clinical conditions. The aim of this paper is to show the information indicating the existence of a correlation between dysbiosis and an increase in the risk of obstetric disorders. Further analysis is also required to clarify the mechanism of the effect of dysbiosis on the disruption of metabolic and biochemical processes within the reproductive system during pregnancy.

The Influence of Acid-Base Balance on Anesthetic Muscle Relaxants: A Comprehensive Review on Clinical Applications and Mechanisms.

Muscle relaxants have broad application in anesthesiology. They can be used for safe intubation, preparing the patient for surgery, or improving mechanical ventilation. Muscle relaxants can be classified based on their mechanism of action into depolarizing and non-depolarizing muscle relaxants and centrally acting muscle relaxants. Non-depolarizing neuromuscular blocking drugs (NMBDs) (eg, tubocurarine, atracurium, pipecuronium, mivacurium, pancuronium, rocuronium, vecuronium) act as competitive antagonists of nicotine receptors. By doing so, these drugs hinder the depolarizing effect of acetylcholine, thereby eliminating the potential stimulation of muscle fibers. Depolarizing drugs like succinylcholine and decamethonium induce an initial activation (depolarization) of the receptor followed by a sustained and steady blockade. These drugs do not act as competitive antagonists; instead, they function as more enduring agonists compared to acetylcholine itself. Many factors can influence the duration of action of these drugs. Among them, electrolyte disturbances and disruptions in acid-base balance can have an impact. Acidosis increases the potency of non-depolarizing muscle relaxants, while alkalosis induces resistance to their effects. In depolarizing drugs, acidosis and alkalosis produce opposite effects. The results of studies on the impact of acid-base balance disturbances on non-depolarizing relaxants have been conflicting. This work is based on the available literature and the authors' experience. This article aimed to review the use of anesthetic muscle relaxants in patients with acid-base disturbances.

Postoperative Hormonal and Water Balance Disturbances After Non-Functioning Pituitary Macroadenoma Surgery

Non-functioning pituitary adenomas (NFPAs) are common sellar region tumors. Certain pituitary adenomas are categorized as functional, as they arise from specific cell types that excessively secrete hormones. In contrast, non-functional adenomas do not secrete hormones but can potentially compress the surrounding regions. The lack of hormonal activity in NFPAs often leads to a delayed diagnosis. It becomes clinically significant when the adenoma gets larger and starts causing symptoms. A 52-year-old man presented with visual field impairment since two years ago and throbbing headaches for the last three months. He was found to have pituitary macroadenoma and no hormonal excess was detected. He was diagnosed with non-functioning pituitary macroadenoma, then underwent endonasal endoscopic transsphenoidal hypophysectomy as a surgical procedure in our institute. A surgical procedure to remove pituitary adenomas can lead to high chance of complications in pituitary hormone regulation due to the manipulation of the pituitary gland and its stalk, such as water balance imbalance and hormonal disturbances. Endonasal endoscopic transsphenoidal hypophysectomy as a surgical procedure in treating pituitary macroadenoma has proven effective, resulting in good outcomes. A multidisciplinary approach involving specialists in endocrinology, ophthalmology, and neurosurgery is essential for the comprehensive evaluation of patients with pituitary adenoma.

HISTOSTRUCTURAL ALTERATIONS IN THE CEREBRAL ARCHITECTURE ASSOCIATED WITH THE PROGRESSION OF ALCOHOL INTOXICATION: AN EXPERIMENTAL ANALYSIS

The aim of this study is to evaluate the histological changes in the cerebellum of rat brains following chronic alcohol intoxication. Materials and Methods. We employed a classical approach for modeling chronic alcohol intoxication by administering 40% ethanol to rats (n=55) in a dosage of 2 ml per 100 g of body weight daily for three months. The cerebellar structure was then analyzed. Results. This study investigates the impact of chronic alcohol intoxication on the histological structures of the cerebellar cortex. The cerebellum, like the nervous system overall, possesses a significant cellular and functional reserve. However, teratogenic factors, including ethanol, notably influence the activity of cerebellar neurons, increasing it. Ethanol exposure during early pregnancy can lead to prenatal growth retardation, stillbirth, cleft palate, hydrocephaly, and reductions in fetal body size. There is evidence suggesting a correlation between blood ethanol levels and a reduction in the number of Purkinje cells. Chronic alcohol consumption results in cerebellar ataxia, alterations in upper limb movements, decreased reaction speeds, reduced attention concentration, impaired coordination accuracy, and disturbances in postural stability and balance. Conclusion. The cerebellum, especially during development, is particularly vulnerable to the toxic effects of alcohol. Recent research suggests that changes in the neurotransmission of gamma-aminobutyric acid (GABA)-dependent receptors may contribute to cerebellar dysfunction induced by ethanol. Ethanol exposure increases the release of GABA not only in Purkinje cells but also in the interneurons of the molecular layer and granule cells.

Virtual Reality Applications for Balance Rehabilitation and Efficacy in Addressing Other Symptoms in Multiple Sclerosis—A Review

(1) Background: Since multiple sclerosis (MS) is a neurological pathology known for its disabling effects across many domains, the introduction of virtual reality (VR) usage has been attempted, as it represents a new method of approach to rehabilitation and treatment of chronic neurological pathologies. Encouraging research has explored the use of video game consoles and VR-assisted Robot-Assisted Gait Training (RAGT) to address balance disturbances in this population. (2) Methods: The search involved two databases, Web of Science and PubMed, utilizing a selection of terms including “Virtual reality”, “Multiple sclerosis”, “Balance”, and “Rehabilitation”. Two reviewers initiated and performed the search for articles, subsequently selecting and extracting data from the studies. The PEDro scale was the tool for evaluating the quality of the articles that we introduced in our research. (3) Results: After rigorous scanning, nine articles remained eligible for our study. VR interventions, particularly compared to standard balance training, consistently improved balance in multiple sclerosis. Robotic-assisted technology with 2D VR yielded superior results in balance rehabilitation. VR interventions had varied effects on walking speed. They have shown promise in decreasing the risk of falls and improving patients’ daily lives while reducing fatigue in multiple sclerosis. (4) Conclusions: VR offers comparable or superior benefits to classical exercise and no intervention for balance but does not significantly improve functional mobility. However, it shows the potential to improve quality of life and fatigue in MS patients. Investigation of VR alongside RAGT is important to be performed with larger sample sizes and comprehensive results are needed to fully understand its efficacy in MS rehabilitation.

Burnout and Satisfaction with Work-Life Balance among General Practitioners in Bulgaria during the COVID-19 Pandemic.

The objective of the present study is to analyze the link between the degree of professional burnout among general practitioners in Bulgaria during a pandemic and their satisfaction with the balance between their personal lives and professional lives. A cross-sectional study was conducted during the fourth wave of the COVID-19 pandemic from December 2021 to January 2022 among 377 general practitioners. We identified the presence and level of burnout syndrome among GPs using V. Boyko's method for diagnostics of the severity of symptoms and the phases of formation and completion of the 'occupational burnout' process. Descriptive statistics and parametric and non-parametric tests were used for the analysis. For the significance level of the null hypothesis, we assumed that p < 0.05 at a 95% confidence interval. A total of 96.3% of the GPs had a high level of burnout during the COVID-19 pandemic. They worked more than 8 h a day (74.8%) and more than 5 days a week (69.0%). A total of 86.3% of them were not satisfied with the spare time they had and stated that they could not balance their work and personal lives (67.1%) since the pandemic was announced. A link was found between the level of professional burnout and long working hours (p = 0.022), dissatisfaction with free time (p = 0.028), and the inability to balance work and personal life (p = 0.000), as well as concerns related to safety during the pandemic (p = 0.048). Unrealistically high levels of burnout during the COVID-19 pandemic due to a disturbed work-life balance is a reason to re-evaluate health policies and involve more hospital care doctors at the frontlines to fight against severe infectious diseases. The results of this study could be used to inform policy makers, healthcare managers, and other stakeholders about the factors that have had profound impacts on GPs' stress levels during the COVID-19 pandemic.

Transcatheter transfemoral aortic valve replacement in a patient with acromegaly and severe left ventricular myocardial hypertrophy. Case report

Main causes of secondary hypertrophic cardiomyopathy include acromegalic cardiomyopathy. Heart damage in patients with the acromegaly is mediated both by the direct action of growth hormone and insulin-like growth factor-1, and increased deposition of collagen and lymphomononuclear cells in the myocardium, which leads to architectural changes, disturbances in fluid and electrolyte balance, severe left ventricular myocardial hypertrophy, diastolic and systolic left ventricular dysfunction and chronic heart failure. This article presents the world's first described observation demonstrating the possibility of successful transfemoral aortic valve repair to a comorbid patient with severe aortic stenosis according to the potential risks caused by the active form of the acromegaly.

Assessment of the excitation-inhibition ratio in the Fmr1 KO2 mouse using neuronal oscillation dynamics.

In vitro and ex vivo studies have shown consistent indications of hyperexcitability in the Fragile X Messenger Ribonucleoprotein 1 (Fmr1) knockout mouse model of autism spectrum disorder. We recently introduced a method to quantify network-level functional excitation-inhibition ratio from the neuronal oscillations. Here, we used this measure to study whether the implicated synaptic excitation-inhibition disturbances translate to disturbances in network physiology in the Fragile X Messenger Ribonucleoprotein 1 (Fmr1) gene knockout model. Vigilance-state scoring was used to extract segments of inactive wakefulness as an equivalent behavioral condition to the human resting-state and, subsequently, we performed high-frequency resolution analysis of the functional excitation-inhibition biomarker, long-range temporal correlations, and spectral power. We corroborated earlier studies showing increased high-frequency power in Fragile X Messenger Ribonucleoprotein 1 (Fmr1) knockout mice. Long-range temporal correlations were higher in the gamma frequency ranges. Contrary to expectations, functional excitation-inhibition was lower in the knockout mice in high frequency ranges, suggesting more inhibition-dominated networks. Exposure to the Gamma-aminobutyric acid (GABA)-agonist clonazepam decreased the functional excitation-inhibition in both genotypes, confirming that increasing inhibitory tone results in a reduction of functional excitation-inhibition. In addition, clonazepam decreased electroencephalogram power and increased long-range temporal correlations in both genotypes. These findings show applicability of these new resting-state electroencephalogram biomarkers to animal for translational studies and allow investigation of the effects of lower-level disturbances in excitation-inhibition balance.