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Background: Near-infrared spectroscopy (NIRS) technology can evaluate muscle metabolism and oxygenation. NIRS-based oximeters can measure skeletal muscle oxygen delivery and utilization during static and dynamic work non-invasively. Our goal was to assess the value and usability of NIRS technology in chronic obstructive pulmonary disease (COPD) rehabilitation program., Methods: Forty patients with COPD participated in a 4-week inpatient rehabilitation program that included breathing exercises and personalized cycle/treadmill training adjusted to the functional capacity, physical activity and comorbidities of the patients. A NIRS muscle oxygen monitor was used to measure tissue oxygenation and hemoglobin levels. Total hemoglobin index, average muscle oxygenation, minimal and maximal muscle oxygenation were recorded before and after the rehabilitation program., Results: Rehabilitation resulted improvement in 6 min walking distance (6MWD:335.3 ± 110. vs. 398.3 ± 126.2 m; P < 0.01), maximal inspiratory pressure (MIP: 57.7 ± 22.7 vs. 63.6 ± 18.0 cmH2O; P < 0.01), chest wall expansion (CWE: 2.84 ± 1.26 vs, 4.00 ± 1.76 cm; P < 0.01), breath hold time (BHT: 25.8 ± 10.6 vs. 29.2 ± 11.6 s; P < 0.01) and grip strength (GS: 24.9 ± 11.9 vs. 27.0 ± 11.4 kg; P < 0.01). Quality of life improvement was monitored by COPD Assessment Test (CAT: 17.00 ± 8.49 vs. 11.89 ± 7.3, P < 0.05). Total hemoglobin index (tHb: 12.8 ± 1.3% vs. 12.8 ± 1.4), average muscle oxygenation (SmO2: 67.5 ± 14.4% vs. 65.2 ± 20.4%) showed a tendency for improvement. Maximal muscle oxygenation decreased (SmO2 max: 98.0 ± 20.5% vs. 90.1 ± 14.3%; P < 0.01). Minimal muscle oxygenation increased (SmO2 min: 42.6 ± 12.6% vs. 54.8 ± 14.3%; P < 0.01)., Conclusions: NIRS results showed that muscle oxygenation and microcirculation can be described as a high-risk factor in COPD patients. The 4-week rehabilitation improves functional parameters, quality of life and tissue oxygenation levels in COPD patients.

Patients with chronic obstructive pulmonary disease (COPD) show systemic consequences, such as chronic systemic inflammation leading to changes in the airway, airway penetrability, and endothelial function. Endothelial dysfunction is characterized by a list of alterations of endothelium towards reduced vasodilation, proinflammatory state, detachment and apoptosis of endothelial cells, and development of atherosclerosis. COPD-induced endothelial dysfunction is associated with elevated cardiovascular risk. The increment of physical activities such as pulmonary rehabilitation (PR) training have a significant effect on COPD, thus, PR can be an integrative part of COPD treatment. In this narrative review the focus is on the function of endothelial inflammatory mediators [cytokines, chemokines, and cellular proteases] and pulmonary endothelial cells and endothelial dysfunction in COPD as well as the effects of dysfunction of the endothelium may play in COPD-related pulmonary hypertension. The relationship between smoking and endothelial dysfunction is also discussed. The connection between different pulmonary rehabilitation programs, arterial stiffness and pulse wave velocity (PWV) is presented. Endothelial dysfunction is a significant prognostic factor of COPD, which can be characterized by PWV. We discuss future considerations, like training programs, as an important part of the treatment that has a favorable impact on the endothelial function.

Background: Chronic obstructive pulmonary disease (COPD) may have considerable cardiovascular risk. Physical activity has a paramount role in COPD treatment. Our aim was to evaluate the applicability of arteriograph in COPD and measure the effectiveness of pulmonary rehabilitation on endothelial function., Methods: A total of 40 patients with COPD (FEV 1 : 45.43±20.20%pred, BMI: 27.99±6.98 kg/m 2 , male: female was 21:19, age: 65.47±7.39 years) participated in a 4-week rehabilitation program. We used a patented, invasively validated Arteriograph. Blood pressure, pulse, augmentation index (AIX), pulse wave velocity (PWV), diastolic area index (DAI) were registered with functional measurements in pulmonary rehabilitation., Results: Pulmonary rehabilitation was effective in 6 minutes walking distance (6MWD: 335.32±110.43 vs. 398.32±126.21 m), maximal inspiratory pressure (MIP: 57.72±22.69 vs. 63.63±18.01 cmH 2 O), chest wall expansion (CWE: 2.84±1.26 vs. 4.00±1.76 cm), breath holding time (BHT: 25.77±10.63 to 29.21±11.60 sec) and grip strength (GS: 24.87±11.88 vs. 27.03±11.43 kg) (P<0.05). Improvement in quality of life was monitored by COPD assessment test marker (CAT: 17.00±8.49 vs. 11.89±7.31, P<0.05). Systolic (133.38±22.15 vs. 126.48±20.22 mmHg) and diastolic blood pressure (76.95±14.37 vs. 75.4±12.7 mmHg) showed a reduction tendency. Pulse also decreased (76.95±14.37 vs. 72.53±13.65 bpm). AIX levels showed slight improvement (3.54±35.59% vs. 2.93±30.79%); 23 patients peripheral circulation progressed. The PWV data showed abnormal elasticity with minimal change (11.74±2.13 vs. 11.4±2.73 m/s); although 20 patients showed improvement. DAI detected slightly diminished coronary circulation with moderate improvement (43.32±6.81 vs. 47.1±7.01 m/s)., Conclusions: Elevated arterial stiffness, high PWV turned the COPD patients to the high/very high-risk cluster. Rehabilitation resulted significant improvement in MIP, CWE, BHT, 6MWD, CAT with mild, but favorable changes in blood pressure, pulse, AIX, PWV. As a consequence of the four weeks rehabilitation period overall quality of life improved and cardiovascular risk showed a reduction tendency in COPD., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

The fever of unknown origin from time to time constitutes a serious clinical problem and nearly all diagnostic methods are involved to discover urgently its cause. According to literature data (18)F-fluoro-deoxyglucose PET/CT was successful in 25-70% of cases even in patients without any positive findings with conventional diagnostic techniques. The Hungarian National Health Fund does not include fever of unknown origin in the list of reimbursed (18)F-fluoro-deoxyglucose PET/CT indications. The authors try to illustrate the clinical problem with this case report. Fever of unknown origin persisted in a patient for a year, but conventional diagnostic procedures were unsuccessful to find the cause of the fever. Finally, (18)F-fluoro-deoxyglucose PET/CT indicated a metabolically active focus between the pancreas tail and the spleen. After a long-lasting antibiotic therapy the patient became symptomfree.

The seizure-induced molecular and functional alterations of glutamatergic transmission in the hippocampus have been investigated. Daily repeated epileptic seizures were induced for 12 days by intraperitoneal administration of 4-aminopyridine (4-AP; 4.5 mg/kg) in adult Wistar rats. The seizure symptoms were evaluated on the Racine's scale. One day after the last injection, the brains were removed for in vitro electrophysiological experiments and immunohistochemical analysis. The glutamate receptor subunits NR1, NR2A, NR2B, GluR1, GluR1(flop), GluR2, and KA-2 were studied using the histoblotting method. The semi-quantitative analysis of subunit immunoreactivities in hippocampal layers was performed with densitometry. In the hippocampus, increase of GluR1, GluR1(flop) and NR2B immunostaining was observed in most of the areas and layers. The significant decrease of GluR2 staining intensity was observed in the CA1 and dentate gyrus. Calcium permeability of hippocampal neurons was tested by a cobalt uptake assay in hippocampal slices. The uptake of cobalt increased in the CA1 area and dentate gyrus, but not in the CA3 region following 4-AP treatment. Effects of AMPA and NMDA (N-methyl-d-aspartate) glutamate receptor antagonists (1-(4-aminophenyl)-4-methyl-7,8-methylenedioxy-5H-2,3-benzodiazepine hydrochloride (GYKI 52466) and D-APV respectively) were measured in hippocampal slices using extracellular recording. Analysis of the population spikes revealed the reduced effectiveness of the AMPA receptor antagonist GYKI 52466, while the effect of the NMDA receptor antagonist d-(2R)-amino-5-phosphonovaleric acid was similar to controls. The results demonstrated that repeated convulsions induced structural and functional changes in AMPA receptor-mediated transmission, while NMDA and kainate receptor systems displayed only alterations in receptor subunit composition.