[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors]. / Az agydaganat mutéti kezelését követo rehabilitáció lehetosége, eredményei.

BACKGROUND AND PURPOSE: Authors examined the rehabilitation possi-bi-lities, necessities, and results of patients after operation with brain tumor, and report their experiences. METHODS: Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. RESULTS: At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. CONCLUSION: Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors' experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery.

[Bronchoscopy-guided decannulation of tracheostomy in patients with brain injury]. / Agysérült betegek tracheostomájának dekanülálása bronchoszkópos ellenorzés mellett.

INTRODUCTION: Progress in intensive care management of patients with severe brain injury due to trauma or vascular lesion significantly improved the mortality and increased the number of patients with tracheostomy who undergo treatment in rehabilitation departments. AIM: The aim of the authors was to describe the safe tracheostomy decannulation method of patients with brain injury during rehabilitation. METHOD: A prospective, descriptive study performed at the rehabilitation departments of the National Institute for Medical Rehabilitation in Budapest, Hungary. RESULTS: From January 1 until December 31, 2013, thirty examinations with flexible bronchoscope for tracheostomy decannulation were performed in 20 patients. The patients were admitted to the rehabilitation wards with various brain injuries: 6 patients suffered from trauma, 5 had ischemic stroke, 3 patients had brain stem haemorrhage, 2 patients cerebellar and one patient bifrontal haemorrhage. One patient had menangioma, and one had multiple organ failure and anoxic brain injury caused by pneumonia. The average age of patients was 44 years (range, 18-80 years). During the procedure successful decannulation was performed in 13 patients. Decannulation occurred 62 days after tracheostomy on average. CONCLUSIONS: Safe patient care requires that various medical departments keep pace with the development of different specialities. To ensure early rehabilitation of patients with severe brain injury having tracheostomy, safe treatment and, if possible, decannulation should be performed. This procedure requires the involvement of a physician with bronchoscopy skills as well as the development of local protocols.

Exploiting a Phage-Bacterium Interaction System as a Molecular Switch to Decipher Macromolecular Interactions in the Living Cell.

Pathogenicity islands of Staphylococcus aureus are under the strong control of helper phages, where regulation is communicated at the gene expression level via a family of specific repressor proteins. The repressor proteins are crucial to phage-host interactions and, based on their protein characteristics, may also be exploited as versatile molecular tools. The Stl repressor from this protein family has been recently investigated and although the binding site of Stl on DNA was recently discovered, there is a lack of knowledge on the specific protein segments involved in this interaction. Here, we develop a generally applicable system to reveal the mechanism of the interaction between Stl and its cognate DNA within the cellular environment. Our unbiased approach combines random mutagenesis with high-throughput analysis based on the lac operon to create a well-characterized gene expression system. Our results clearly indicate that, in addition to a previously implicated helix-turn-helix segment, other protein moieties also play decisive roles in the DNA binding capability of Stl. Structural model-based investigations provided a detailed understanding of Stl:DNA complex formation. The robustness and reliability of our novel test system were confirmed by several mutated Stl constructs, as well as by demonstrating the interaction between Stl and dUTPase from the Staphylococcal ϕ11 phage. Our system may be applied to high-throughput studies of protein:DNA and protein:protein interactions.

Cross-species inhibition of dUTPase via the Staphylococcal Stl protein perturbs dNTP pool and colony formation in Mycobacterium.

Proteins responsible for the integrity of the genome are often used targets in drug therapies against various diseases. The inhibitors of these proteins are also important to study the pathways in genome integrity maintenance. A prominent example is Ugi, a well known cross-species inhibitor protein of the enzyme uracil-DNA glycosylase, responsible for uracil excision from DNA. Here, we report that a Staphylococcus pathogenicity island repressor protein called StlSaPIbov1 (Stl) exhibits potent dUTPase inhibition in Mycobacteria. To our knowledge, this is the first indication of a cross-species inhibitor protein for any dUTPase. We demonstrate that the Staphylococcus aureus Stl and the Mycobacterium tuberculosis dUTPase form a stable complex and that in this complex, the enzymatic activity of dUTPase is strongly inhibited. We also found that the expression of the Stl protein in Mycobacterium smegmatis led to highly increased cellular dUTP levels in the mycobacterial cell, this effect being in agreement with its dUTPase inhibitory role. In addition, Stl expression in M. smegmatis drastically decreased colony forming ability, as well, indicating significant perturbation of the phenotype. Therefore, we propose that Stl can be considered to be a cross-species dUTPase inhibitor and may be used as an important reagent in dUTPase inhibition experiments either in vitro/in situ or in vivo.