143 resultados para lätt trafik
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Bakgrund: Alzheimers sjukdom är den vanligaste bland demenssjukdomar som medför emotionella störningar och personlighetsförändringar. De flesta personer med Alzheimers har en önskan om att bo hemma och många familjer gör sitt bästa för att uppnå detta. Syfte: Studiens syfte var att belysa anhörigas upplevelser av att vårda personer med Alzheimers sjukdom. Metod: Denna systematiska litteraturstudie är baserad på fjorton vetenskapliga artiklar inom det valda området. Dessa har analyserats med en innehållsanalys. Resultat: Studien visade att det är påfrestande att vara anhörigvårdare. En rad olika upplevelser framkom, både negativa och positiva, dock mest negativa. Stöd visade sig vara viktigt för anhörigvårdarna och många ansåg sig sakna det. Manliga och kvinnliga upplevelser gällande anhörigvård skiljde sig från varandra. Kvinnor hade mer negativa upplevelser än män. Slutsats: Att vårda en anhörig i hemmet är inte en lätt uppgift. Därför anser författarna att det krävs mer forskning i området för att kunna bemöta anhörigvårdarnas behov.
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BACKGROUND: Quinolones are widely used, broad spectrum antibiotics that can induce immediate- and delayed-type hypersensitivity reactions, presumably either IgE or T cell mediated, in about 2-3% of treated patients. OBJECTIVE: To better understand how T cells interact with quinolones, we analysed six patients with delayed hypersensitivity reactions to ciprofloxacin (CPFX), norfloxacin (NRFX) or moxifloxacin (MXFX). METHODS: We confirmed the involvement of T cells in vivo by patch test and in vitro by means of the lymphocyte proliferation test (LTT). The nature of the drug-T cell interaction as well as the cross-reactivity with other quinolones were investigated through the generation and analysis (flow cytometry and proliferation assays) of quinolone-specific T cell clones (TCC). RESULTS: The LTT confirmed the involvement of T cells because peripheral blood mononuclear cells (PBMC) mounted an enhanced in vitro proliferative response to CPFX and/or NRFX or MXFX in all patients. Patch tests were positive after 24 and 48 h in three out of the six patients. From two patients, CPFX- and MXFX-specific CD4(+)/CD8(+) T cell receptor (TCR) alphabeta(+) TCC were generated to investigate the nature of the drug-T cell interaction as well as the cross-reactivity with other quinolones. The use of eight different quinolones as antigens (Ag) revealed three patterns of cross-reactivity: clones exclusively reacting with the eliciting drug, clones with a limited cross-reactivity and clones showing a broad cross-reactivity. The TCC recognized quinolones directly without need of processing and without covalent association with the major histocompatability complex (MHC)-peptide complex, as glutaraldehyde-fixed Ag-presenting cells (APC) could present the drug and washing quinolone-pulsed APC removed the drug, abrogating the reactivity of quinolone-specific TCC. CONCLUSION: Our data show that T cells are involved in delayed immune reactions to quinolones and that cross-reactivity among the different quinolones is frequent.
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BACKGROUND: T cells play a key role in delayed-type drug hypersensitivity reactions. Their reactivity can be assessed by their proliferation in response to the drug in the lymphocyte transformation test (LTT). However, the LTT imposes limitations in terms of practicability, and an alternative method that is easier to implement than the LTT would be desirable. METHODS: Four months to 12 years after acute drug hypersensitivity reactions, CD69 upregulation on T cells of 15 patients and five healthy controls was analyzed by flow cytometry. RESULTS: All 15 LTT-positive patients showed a significant increase of CD69 expression on T cells after 48 h of drug-stimulation exclusively with the drugs incriminated in drug-hypersensitivities. A stimulation index of 2 as cut-off value allowed discrimination between nonreactive and reactive T cells in LTT and CD69 upregulation. T cells (0.5-3%) showed CD69 up-regulation. The reactive cell population consisted of a minority of truly drug reactive T cells secreting cytokines and a higher number of bystander T cells activated by IL-2 and possibly other cytokines. CONCLUSIONS: CD69 upregulation was observed after 2 days in all patients with a positive LTT after 6 days, thus appearing to be a promising tool to identify drug-reactive T cells in the peripheral blood of patients with drug-hypersensitivity reactions.
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Background: The lymphocyte transformation test (LTT) is used for in vitro diagnosis of drug hypersensitivity reactions. While its specificity is over 90%, sensitivity is limited and depends on the type of reaction, drug and possibly time interval between the event and analysis. Removal of regulatory T cells (Treg/CD25(hi)) from in vitro stimulated cell cultures was previously reported to be a promising method to increase the sensitivity of proliferation tests. Objective: The aim of this investigation is to evaluate the effect of removal of regulatory T cells on the sensitivity of the LTT. Methods: Patients with well-documented drug hypersensitivity were recruited. Peripheral blood mononuclear cells, isolated CD3(+) and CD3(+) T cells depleted of the CD25(hi) fraction were used as effector cells in the LTT. Irrelevant drugs were also included to determine specificity. (3)H-thymidine incorporation was utilized as the detection system and results were expressed as a stimulation index (SI). Results: SIs of 7/11 LTTs were reduced after a mean time interval of 10.5 months (LTT 1 vs. LTT 2). Removal of the CD25(hi) fraction, which was FOXP3(+) and had a suppressive effect on drug-induced proliferation, resulted in an increased response to the relevant drugs. Sensitivity was increased from 25 to 82.35% with dramatically enhanced SI (2.05 to 6.02). Specificity was not affected. Conclusion: Removal of Treg/CD25(hi) cells can increase the frequency and strengths of drug-specific proliferation without affecting specificity. This approach might be useful in certain drug hypersensitivity reactions with borderline responses or long time interval since the hypersensitivity reaction. © 2014 S. Karger AG, Basel.
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BACKGROUND Allopurinol is a main cause of severe cutaneous adverse reactions (SCAR). How allopurinol induces hypersensitivity remains unknown. Pre-disposing factors are the presence of the HLA-B*58:01 allele, renal failure and possibly the dose taken. OBJECTIVE Using an in vitro model, we sought to decipher the relationship among allopurinol metabolism, HLA-B*58:01 phenotype and drug concentrations in stimulating drug-specific T cells. METHODS Lymphocyte transformation test (LTT) results of patients who had developed allopurinol hypersensitivity were analysed. We generated allopurinol or oxypurinol-specific T cell lines (ALP/OXP-TCLs) from allopurinol naïve HLA-B*58:01(+) and HLA-B*58:01(-) individuals using various drug concentrations. Their reactivity patterns were analysed by flow cytometry and (51) Cr release assay. RESULTS Allopurinol allergic patients are primarily sensitized to oxypurinol in a dose-dependent manner. TCL induction data show that both the presence of HLA-B*58:01 allele and high concentration of drug are important for the generation of drug-specific T cells. The predominance of oxypurinol-specific lymphocyte response in allopurinol allergic patients can be explained by the rapid conversion of allopurinol to oxypurinol in vivo rather than to its intrinsic immunogenicity. OXP-TCLs do not recognize allopurinol and vice versa. Finally, functional avidity of ALP/OXP-TCL is dependent on both the induction dose and HLA-B*58:01 status. CONCLUSIONS AND CLINICAL RELEVANCE This study establishes the important synergistic role of drug concentration and HLA-B*58:01 allele in the allopurinol or oxypurinol-specific T cell responses. Despite the prevailing dogma that Type B adverse drug reactions are dose independent, allopurinol hypersensitivity is primarily driven by oxypurinol-specific T cell response in a dose-dependent manner, particular in the presence of HLA-B*58:01 allele.
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BACKGROUND Patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) are often exposed simultaneously to a few potentially culprit drugs. However, both the standard lymphocyte transformation tests (LTT) with proliferation as the assay end-point as well as skin tests, if done, are often negative. OBJECTIVE As provocation tests are considered too dangerous, there is an urgent need to identify the relevant drug in SJS/TEN and to improve sensitivity of tests able to identify the causative drug. METHODS Fifteen patients with SJS/TEN with the ALDEN score ≥ 6 and 18 drug-exposed controls were included. Peripheral blood mononuclear cells (PBMC) were isolated and cultured under defined conditions with drugs. LTT was compared to the following end-points: cytokine levels in cell culture supernatant, number of granzyme B secreting cells by ELISpot and intracellular staining for granulysin and IFNγ in CD3(+) CD4(+), CD3(+) CD8(+) and NKp46(+) cells. To further enhance sensitivity, the effect of IL-7/IL-15 pre-incubation of PBMC was evaluated. RESULTS Lymphocyte transformation tests was positive in only 4/15 patients (sensitivity 27%, CI: 8-55%). Similarly, with granzyme B-ELISpot culprit drugs were positive in 5/15 patients (sensitivity 33%, CI: 12-62%). The expression of granulysin was significantly induced in NKp46(+) and CD3(+) CD4(+) cells (sensitivity 40%, CI: 16-68% and 53%, CI: 27-79% respectively). Cytokine production could be demonstrated in 38%, CI: 14-68% and 43%, CI: 18-71% of patients for IL-2 and IL-5, respectively, and in 55%, CI: 23-83% for IFNγ. Pre-incubation with IL-7/IL-15 enhanced drug-specific response only in a few patients. Specificities of tested assays were in the range of 95 (CI: 80-99%)-100% (CI: 90-100%). CONCLUSIONS AND CLINICAL RELEVANCE Granulysin expression in CD3(+) CD4(+) , Granzyme B-ELISpot and IFNγ production considered together provided a sensitivity of 80% (CI: 52-96%) and specificity of 95% (80-99%). Thus, this study demonstrated that combining different assays may be a feasible approach to identify the causative drug of SJS/TEN reactions; however, confirmation on another group of patients is necessary.
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Bei Medikamentenallergien kommt es zu Immunreaktionen, die gegen das Medikament gerichtet sind und klinische Symptome verursachen. Man unterscheidet zwischen Hapten- und p-i-bedingten Reaktionen, wobei letztere nur für T-Zell-Reaktionen nachgewiesen wurden. Die häufigsten Immunmechanismen, welche Medikamentenallergien zugrunde liegen, sind Vermehrung von spezifischen IgE-produzierenden B- und/oder spezifischen T-Zellen. IgG-vermittelte Reaktionen, die z.B. eine hämolytische Anämie verursachen können, sind selten. Spezifische IgE können mittels CAP-Technologie nachgewiesen werden. Das Medikament muss an eine Trägersubstanz covalent gebunden werden, was den Nachteil mit sich bringt, dass die entsprechende Bindungsstelle im Medikament für IgE nicht erkennbar ist. Der Basophilenaktivierungstest (BAT) arbeitet meist mit freiem, ungebundenem Medikament. Wie die IgE-Vernetzung stattfindet, ist allerdings unklar. Beide Teste sind nicht genügend sensitiv um den In-vivo-Test (Prick oder i.d.) zu ersetzen. Bei T-Zell-Reaktionen wird in vitro meist die Proliferation der durch das Medikament stimulierten T-Zellen erfasst. Die Blutzellen (antikoaguliertes Blut) sollte innerhalb von 24 h im Labor zur Verarbeitung ankommen, wo die Zellseparation durchgeführt wird, um die Zellen mit dem Medikament zu stimulieren. Diese Stimulation kann durch Messung von Aktivierungsmarker (mittels Flow-Zytometrie), sezernierter Zytokine (ELISA) oder 3H-Thymidin Einbau in die sich teilende Zellen (Lymphozytentransformations- Test, LTT) erfasst werden. Am meisten Erfahrung liegt für den LTT vor. Die Sensitivität wird bei eindeutigen Fällen auf 50 – 70% geschätzt, hängt aber stark vom Krankheitsbild und Medikament ab. Schwere makulopapulöse Reaktionen und DRESS (Drug Rash with Eosinophilia and Systemic Symptoms), AGEP (acute generalized exanthematous pustulosis) sind meist positiv im LTT, aber schwere bullöse Reaktionen (SJS/TEN; Stevens-Johnson Syndrom/toxische epidermale Nekrolyse) werden besser mittels Zytotoxteste und Zytokinsekretion erfasst, da eine T-Zell-Proliferation weniger prominent ist. Trotz der limitierten Sensitivität sind diese Teste gut geeignet um Kreuzreaktionen zu erfassen, bzw. für mechanistische Studien. Da Provokationsteste bei verzögerten Medikamentenallergien nicht zur Verfügung stehen (es ist unklar, wie lange und wie hoch dosiert man das Medikament bei verzögerten Reaktionen geben muss), werden diese Teste in Zukunft eher mehr eingesetzt werden. Wichtig ist, dass sie selten falsch positiv sind, und ein positives Resultat als relevant angesehen werden kann. Für die Abklärung seltener IgG-vermittelter Reaktionen kann man einen modifizierten Coombs-Test versuchen.
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INTRODUCTION Erythema exsudativum multiforme majus (EEMM) and Stevens-Johnson Syndrome (SJS) are severe cutaneous reaction patterns caused by infections or drug hypersensitivity. The mechanism by which widespread keratinocyte death is mediated by the immune system in EEMM/SJS are still to be elucidated. Here, we characterized the blister cells isolated from a patient with EEMM/SJS overlap and investigated its cause. METHODS Clinical classification of the cutaneous eruption was done according to the consensus definition of severe blistering skin reactions and histological analysis. Common infectious causes of EEMM were investigated using standard clinical techniques. T cell reactivity for potentially causative drugs was assessed by lymphocyte transformation tests (LTT). Lymphocytes isolated from blister fluid were analyzed for their expression of activation markers and cytotoxic molecules using flow cytometry. RESULTS The healthy 58 year-old woman suffered from mild respiratory tract infection and therefore started treatment with the secretolytic drug Ambroxol. One week later, she presented with large palmar and plantar blisters, painful mucosal erosions, and flat atypical target lesions and maculae on the trunc, thus showing the clinical picture of an EEMM/SJS overlap (Fig. 1). This diagnosis was supported by histology, where also eosinophils were found to infiltrate the upper dermis, thus pointing towards a cutaneous adverse drug reaction (cADR). Analysis of blister cells showed that they mainly consisted of CD8+ and CD4+ T cells and a smaller population of NK cells. Both the CD8+ T cells and the NK cells were highly activated and expressed Fas ligand and the cytotoxic molecule granulysin (Fig. 2). In addition, in comparison to NK cells from PBMC, NK cells in blister fluids strongly upregulated the expression of the skin-homing chemokine receptor CCR4 (Fig 4). Surprisingly, the LTT performed on PBMCs in the acute phase was positive for Ambroxol (SI=2.9) whereas a LTT from a healthy but exposed individual did not show unspecific proliferation. Laboratory tests for common infectious causes of EEMM were negative (HSV-1/-2, M. pneumoniae, Parvovirus B19). However, 6 weeks later, specific proliferation to Ambroxol could no longer be observed in the LTT (Fig 4.).
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Four samples, G5, G7, G8, and G10, collected by Dr W. W. Bishop from an exposed section in the bank of the River Annan, at Roberthill Farm, Dumfriesshire (S35, 110794) were submitted for pollen analysis (Table I.). The samples, with the exception of the uppermost, were from thin peat layers that lie in the middle of a series of water- laid sands, silts and clays several feet in thickness and now rather strongly arched. The lowermost sample, G5, was taken from an organic layer about | in. thick overlying fine sand and underlying some 2.5 in. of grey, silty fine sand. A narrow layer of sandy peat immediately above the silty, fine sand yielded sample G7, and G8 was collected from a similar peaty layer separated from G7 by more sandy- silty peat. The uppermost sample, G10, was taken from light grey clay 13 in. above sample G8.
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Site details: The raised bog Fláje-Kiefern (50°429N, 13°329 E; 760 m a.s.l.; size ca. 500x500 m) lies in the Krusné Hory Mountains (Erzgebirge), Czech Republic, about 10 km from Georgenfelder Moor in Germany. Hejny and Slavík (1988) described the phytogeographic region of the Krusne Hory Mountains as 'a region of mountain flora and vegetation, with thermophilous species largely missing. In the natural forests, conifers, especially spruce (Picea excelsa) prevail. The deforested areas have been converted into meadows and pastures'. The climate is cool with annual average temperatures of about 5°C and annual precipitation of about 900 mm. The bedrock is Precambrian crystallinicum.
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Studies combining sedimentological and biological evidence to reconstruct Holocene climate beyond the major changes, and especially seasonality, are rare in Europe, and are nearly completely absent in Germany. The present study tries to reconstruct changes of seasonality from evidence of annual algal successions within the framework of well-established pollen zonation and 14C-AMS dates from terrestrial plants. Laminated Holocene sediments in Lake Jues (10°20.70' E, 51°39.30' N, 241 m a.s.l.), located at the SW margin of the Harz Mountains, central Germany, were studied for sediment characteristics, pollen, diatoms and coccal green algae. An age model is based on 21 calibrated AMS radiocarbon dates from terrestrial plants. The sedimentary record covers the entire Holocene period. Trophic status and circulation/stagnation patterns of the lake were inferred from algal assemblages, the subannual structure of varves and the physico-chemical properties of the sediment. During the Holocene, mixing conditions alternated between di-, oligo- and meromictic depending on length and variability of spring and fall periods, and the stability of winter and summer weather. The trophic state was controlled by nutrient input, circulation patterns and the temperature-dependent rates of organic production and mineralization. Climate shifts, mainly in phase with those recorded from other European regions, are inferred from changing limnological conditions and terrestrial vegetation. Significant changes occurred at 11,600 cal. yr. BP (Preboreal warming), between 10,600 and 10,100 cal. yr. BP (Boreal cooling), and between 8,400 and 4,550 cal. yr. BP (warm and dry interval of the Atlantic). Since 4,550 cal. yr. BP the climate became gradually cooler, wetter and more oceanic. This trend was interrupted by warmer and dryer phases between 3,440 and 2,850 cal. yr. BP and, likely, between 2,500 and 2,250 cal. yr. BP.
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Utvecklingen av sociala medier såsom t.ex. Facebook och Instagram har inneburit nya möjligheter att kommunicera sin livsstil och sina personliga val, som överskrider såväl kulturella som geografiska gränser. Nya gemenskaper skapas. Detta får betydelse för hur konsumenter kommunicerar med varandra samt hur märkesinnehavarna kommunicerar med sina kunder. Syftet med min studie är att undersöka hur en märkesinnehavare inom mode använder sociala medier, i detta fall Instagram, i sin kommunikation med kunderna för att skapa engagemang kring sitt varumärke. Aktuell forskning visar att värde i varumärket skapas genom en ömsesidig kommunikation mellan märkesinnehavaren och konsumenterna. Kommunikationen sker både mellan märkesinnehavare och konsumenter samt mellan konsumenterna i en märkesgemenskap. Storytelling är ett verksamt medel i denna meningsskapande process. En semiotisk analys användes för att analysera bilderna och hur de bidrar till märkets storytelling. Resultatet visar att Instagram ger märkesinnehavare och konsumenter möjlighet att gemensamt skapa värde. De tekniska funktionerna i applikationen gör det lätt för märkesinnehavare att interagera med sina konsumenter och skapa en dynamisk märkesgemenskap. På Sabo Skirts instagramkonto är märkesinnehavaren och följarna tillsammans märkets författare. Följarna använder kläderna och ger dem betydelse i sin egen vardag samtidigt som märkesinnehavaren skapar möjligheter för dem att synas på ett instagramkonto med 1,5 miljoner följare. Detta kan tolkas med hjälp av teorin uses and gratifications som säger att användningen av media alltid är målinriktad. Människor väljer aktivt media efter vilka deras behov är och hur väl användningen tillfredsställer dessa behov.
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A szerző kutatási célja, hogy megvizsgálja, vajon a hazai vállalatok mai gyakorlatában a fejlettebb logisztikai képességek együtt járnak-e magasabb teljesítménnyel. Az elemzés a Budapesti Corvinus Egyetem Vállalat-gazdaságtan Intézete mellett működő Versenyképesség Kutató Központ vállalati versenyképességet vizsgáló kérdőíves felmérés immár 4. fordulójának adatbázisát használja, melyet 2009 folyamán összesen 300 vállalat vezetőinek megkérdezésével hoztak létre. Ennek az adatbázisnak a felhasználásával a cikk két kérdésre keresi a választ. A szerző egyrészt megvizsgálja, vajon a mintában kimutatható-e egy fejlettebb logisztikai képességekkel rendelkező vállalatcsoport. Másrészt arra is kíváncsi, vajon ezek a fejlettebb logisztikai képességek együtt járnak-e a vállalatok magasabb teljesítményével. A 2009-es adatok elemzése igazolta, hogy logisztikai képességekben két szignifikánsan eltérő fejlettségű vállalatcsoport létét. Az eredményekből az is kiolvasható, hogy a magasabb logisztikai képességek a mintában együtt jártak a magasabb működési teljesítménnyel is. _________________ The overall objective of the paper is to investigate the relationship between logistics capabilities and company’s performance. Empirical analysis is carried out based on an extensive questionnaire developed and conducted at the Competitive Research Center at the Corvinus University of Budapest in 2009. Using this database the author had two separate research questions: Can she detect companies in their sample with significantly different logistics capabilities. If yes, does more developed logistics lead to higher level performance at the company level? After carrying out their empirical analysis they could state, that they could prove the existence of two clusters, one with less and another with more developed logistics capabilities. They also were able to show that firms with more developed logistics can achieve significantly higher operational performance and can be characterized with a more developed customer orientation.
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A közgazdaságtanban az ágensalapú modellezés egyik alkalmazási területe a makro ökonómia. Ebben a tanulmányban néhány népszerű megtakarítási szabály létét feltételezve adaptív-evolúciós megközelítésben endogén módon próbálunk következtetni e szabályok relatív életképességére. Három különböző típusú ágenst vezetünk be: egy prudens, egy rövidlátó és egy, a permanensjövedelem-elméletnek megfelelően működőt. Rendkívül erős szelekciós nyomás mellett a prudens típus egyértelműen kiszorítja a másik kettőt. A második legéletképesebbnek a rövidlátó típus tűnik, de már közepes szelekciós nyomásnál sem tűnik el egyik típus sem. Szokásos tőkehatékonyság mellett a prudens típus túlzott beruházási tendenciát visz a gazdaságba, és a gazdaság az aranykori megtakarítási rátánál magasabbat ér el. A hitelkorlátok oldása még nagyobb mértékű túlzott beruházáshoz vezethet, a hitelek mennyiségének növekedése mellett a tőketulajdonosok mintegy "kizsákmányoltatják" magukat azokkal, akiknek nincs tőkejövedelmük. A hosszú távú átlagos fogyasztás szempontjából a három típus kiegyensúlyozott aránya adja a legjobb eredményt, ugyanakkor ez jóval nagyobb ingadozással jár, mint amikor csak prudens típusú háztartások léteznek. ____ Agent-based modelling techniques have been employed for some time in macroeconomics. This paper tests some popular saving rules in an adaptive-evolutionary context of looking at their relative survival values. The three types are prudent, short-sighted, and responsive to the permanent-income hypothesis. It is found that where selection pressure is very high, only the prudent type persists. The second most resilient seems to be the short-sighted type, but all three coexist even at medium levels of selection pressure. When the efficiency of capital approaches the level usually assumed in macroeconomics, the prudent type drives the economy towards excessive accumulation of capital, i. e. a long-term savings rate that exceeds the golden rule. If credit constraints are relaxed, this tendency strengthens as credit grows and capital-owners seem to allow themselves to be exploited" by workers. From the angle of average consumption, the best outcome is obtained from a random distribution of types, although this is accompanied by higher volatility.
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Metamaterials have attracted great attention in recent decades, due to their electromagnetic properties which are not found in nature. Since metamaterials are now synthesized by the insertion of artificially manufactured inclusions in a specified homogeneous medium, it became possible for the researcher to work with a wide collection of independent parameters, for example, the electromagnetic properties of the material. An investigation of the properties of ring resonators was performed as well as those of metamaterials. A study of the major theories that clearly explain superconductivity was presented. The BCS theory, London Equations and the Two-Fluid Model are theories that support the application of superconducting microstrip antennas. Therefore, this thesis presents theoretical, numerical and experimental-computational analysis using full-wave formalism, through the application of the Transverse Transmission Line – LTT method applied in the Fourier Transform Domain (FTD). The LTT is a full wave method, which, as a rule, obtains the electromagnetic fields in terms of the transverse components of the structure. The inclusion of the superconducting patch is performed using the complex resistive boundary condition. Results of resonant frequency as a function of antenna parameters are obtained. To validate the analysis, computer programs were developed using Fortran, simulations were created using the commercial software, with curves being drawn using commercial software and MATLAB, in addition to comparing the conventional patch with the superconductor as well as comparing a metamaterial substrate with a conventional one, joining the substrate with the patch, observing what improves on both cas