A májfibrosis nem invazív jellemzésének lehetőségei a klinikai adatok tükrében

Liver cirrhosis is one of the leading causes of death worldwide. Liver biopsy is considered as the gold standard for the diagnosis of chronic liver diseases. Studies have focused on non-invasive markers for liver fibrosis because of the dangers and complications of liver biopsy. The authors review the non-invasive direct as well as indirect methods for liver fibrosis assessment and present the positive and negative predictive value, sensitivity and specificity of those. Clinical utilities of transient elastography (Fibrsocan) is also reviewed. Non-invasive methods are useful in the assessment of liver fibrosis, monitoring disease progression and therapeutic response. Their accuracy can be increased by the combined or sequential use of non-invasive markers

Bél-máj tengely vizsgálata colitis ulcerosaban – retrospektív tanulmány

Absztrakt: Bevezetés: A bél–máj tengely vizsgálata világszerte előtérbe került. A gyulladásos bélbetegségben szenvedőknél gyakran tapasztalható májenzim-emelkedés, amely diagnosztikus kihívást jelent a mindennapi gyakorlatban. A máj és az epeutak megbetegedései gyakori extraintestinalis manifesztációk mind Crohn-betegségben, mind colitis ulcerosában. A rutin májfunkciós paraméterek meghatározása nem ad pontos képet a májműködési zavarról, így azok prevalenciája alulbecsült lehet. Szükség lenne olyan nem invazív biomarkerek és/vagy pontrendszerek bevezetésére, amelyek a bélbetegségekhez társult májkárosodások diagnosztikájában segítséget nyújtanának. Célkitűzés: Munkánk során fontosnak tartottuk, hogy kiemeljük a bél–máj tengely jelentőségét. Colitis ulcerosában szenvedő betegek adatait használtuk fel bélbetegségek modelljeként, és megvitatjuk a májkárosodás patogenezise hátterében álló lehetséges tényezőket. Módszer: Retrospektív munkánk során mérsékelt aktivitású colitis ulcerosában szenvedő betegek (n = 100; férfi = 46, nő = 54; átlagéletkor: 42,5 ± 12,7) adatait elemeztük és hasonlítottuk össze egészséges kontrollokkal (n = 42; férfi = 17, nő = 25; átlagéletkor: 40,2 ± 13,5). Meghatározásra kerültek a májfunkciós paraméterek (ALT, AST, GGT, ALP, bilirubin, albumin, vérlemezkeszám), epesavszintek, valamint különböző szabad gyökös markerek (globális, enzimatikus) segítségével becsültük a betegek redox-homeosztázisát. Mértük a hidrogéndonor-aktivitást, a redukálóképességet, a szuperoxid dizmutáz és a glutation-peroxidáz aktivitásait, az összantioxidáns-státuszt és az indukált kemilumineszcenciát, tekintettel arra, hogy a betegek 5-amino-szalicilsav és/vagy azathioprin és elemi diéta kezelésben részesültek. Eredmények: A májenzim-aktivitások emelkedettebbek voltak colitis ulcerosában, és az összantioxidáns-státusz, valamint a redukálóképesség szignifikánsan csökkent, azonban nem volt szignifikáns különbség a kontrollcsoporthoz képest a glutation-peroxidáz és H-donor-aktivitásban, csak tendenciózus csökkenést tapasztaltunk. Az antioxidánsvédelem a betegcsoportban a betegek 54%-ánál volt szignifikánsan alacsonyabb mértékű az összes paramétert figyelembe véve. Kemilumineszcenciás módszerrel jobb szabadgyök-fogó képességet mértünk, mind a plazmában, mind az erythrocytában az alkalmazott terápia eredményeként, ugyanakkor a szuperoxid dizmutáz aktivitásának növekedését tapasztaltuk, ami a gyulladásos folyamatokra figyelmeztet. Az epesavszintek csökkenését tapasztaltuk a betegcsoportban, aminek okaként a felgyorsult passzázst is számításba kell venni. Következtetések: A mindennapi rutin során meghatározásra kerülő májenzimértékek nem adnak pontos képet a colitis ulcerosában létrejövő májkárosodás mértékéről. Az általunk meghatározott különböző speciális paraméterek segítségével megbecsülhetjük a bél–máj tengely eltéréseinek hátterében álló folyamatokat. Az epesavszint csökkenése prediktív faktornak tekinthető colitis ulcerosában is. Munkánk rávilágít a májbetegségek nem invazív szűrésének szükségességére gyulladásos bélbetegségben. Orv Hetil. 2017; 158(26): 1014–1021. | Abstract: Introduction: Examination of the gut–liver axis came into the spotlight worldwide. Liver enzyme elevations are commonly seen in patients with inflammatory bowel disease (IBD), which is a diagnostic challenge in everyday clinical practice. Liver and biliary diseases are common extra-intestinal manifestations in Crohn’s disease and ulcerative colitis. The assessment of routine liver function tests could be an inaccurate reflection of liver damage, so its prevalence could be underestimated. There would be a need for non-invasive biomarkers and/or scoring systems, which would help the diagnosis of liver damage associated with intestinal diseases. Aim: In our work we considered to highlight the importance of the gut–liver axis significance. We used data of patients suffering from ulcerative colitis, as a model for bowel diseases to understand the underlying factors of the pathogenesis of hepatobiliary manifestations. Method: In our retrospective study, we investigated the data of 100 ulcerative colitis patients (male = 46, female = 54) (mean age: 42.5 ± 12.7) and compared to healthy controls (n = 42) (male = 17, female = 25) (mean age: 40.2 ± 13.5). Liver function tests (ALT, AST, GGT, ALP, bilirubin, albumin, thrombocyte), bile acid levels were determinated, and various free radical markers (global, enzymatic) were used to assess the redox homeostasis of patients. Hydrogen donor activity, reducing power, superoxide dismutase and glutathione peroxidase activity, total antioxidant status and induced chemiluminescence were measured, considering that the patients received 5-aminosalicilate and/or azathioprin and elemental diet treatment. Results: Liver function parameters were increased in ulcerative colitis patients, and total antioxidant status, as well. Reducing power significantly decreased, but there was no significant difference compared to the control group of glutathione peroxidase and H-donor activity, we observed only tendentious decrease. The antioxidant protection of more than 54% of patients had a significantly lower rate, according to all the parameters. With chemiluminescence measurement we measured better free radical scavenging capacity, both in plasma and in erythrocytes as a result of the therapy, however, it showed an increase of superoxide dismutase activity, which warns of inflammatory processes. The cause of the decrease in bile acid levels found in the group of ulcerative colitis patients, can be the accelerated peristaltic. Conclusions: In the daily routine, liver enzyme values do not give an accurate picture of liver damage associated with ulcerative colitis. With the help of various specific parameters determined by us, we can estimate the background processes of the gut–liver axis alterations. The decrease in bile acid levels can be a predictive factor in ulcerative colitis. Our work highlights the need of non-invasive screening for liver diseases in inflammatory bowel disease. Orv Hetil. 2017; 158(26): 1014–1021

Az idült májbetegségek progressziójához vezető folyamatok

As the result of various effects (viruses, metabolic diseases, nutritional factors, toxic agents, autoimmune processes) abnormal liver function, liver steatosis and connective tissue remodeling may develop. Progression of this process is complex including various pathways and a number of factors. The authors summarize the factors involved in the progression of chronic liver disease. They describe the role of cells and the produced inflammatory mediators and cytokines, as well as the relationship between the disease and the intestinal flora. They emphasize the role of oxidative stress, mitochondrial dysfunction and cell death in disease progression. Insulin resistance and micro-elements (iron, copper) in relation to liver damage are also discussed, and genetic and epigenetic aspects underlying disease progression are summarized. Discovery of novel treatment options, assessment of the effectiveness of treatment, as well as the success and proper timing of liver transplantation may depend on a better understanding of the process of disease progression

Tourists\u27 satisfaction with shopping experience based on reviews on TripAdvisor

Although generally not the primary reason for traveling, shopping is considered to be an important part of any tourists\u27 experience. A well-developed, diverse and attractive retail sector could not only generate additional revenues and foreign currency to the local economy but could also contribute to increasing destination attractiveness. It is, then, important for local authorities and for tourism development planners to ensure that tourists are satisfied with their shopping experience at the destination. The goal of this study is to examine the international tourists\u27 overall satisfaction with their shopping experience in Istanbul\u27s modern retail centers and to identify the main reasons for their satisfaction or dissatisfaction. The study will also determine whether or not international tourists\u27 shopping experiences are influenced by their socio-demographic characteristics. The study is based on the quantitative and qualitative content analysis of reviews posted on TripAdvisor, the leading online travel community in the world. Our findings show that international tourists are, in general, satisfied with their shopping experience in Istanbul\u27s malls; however, the reviews also pointed out a number of shortcomings which need to be carefully analyzed and fixed if the authorities intend to transform the city into a global shopping center. We could not document any statistically significant differences between groups based on socio-demographic characteristics such as gender, age, shopping involvement or experience with online reviews. Only world region of origin and the grouping into western and non-western countries were found to be influential in determining statistically significant differences, with tourists from developing countries being more satisfied than their counterparts from western countries

Guest Satisfaction and Dissatisfaction with Pool Attributes at Five-Star Hotels in Dubai

Guest Satisfaction and Dissatisfaction with Pool Attributes at Five-Star Hotels in Dubai. This study investigates the influence of hotel amenities on guest satisfaction, with particular emphasis on swimming pool facilities in luxury hotels. The research employs a mixed-methods approach combining quantitative and qualitative content analysis of guest reviews from Booking.com to identify the key attributes of five-star hotel pools that most significantly affect guest satisfaction levels. The study focuses on Dubai as its research context, selected for its prominence in the global luxury tourism market. The emirate boasts 168 five-star hotels offering approximately 145,000 rooms and serviced apartments, including world-renowned properties such as the Burj Al Arab that serve as both accommodations and tourist destinations in their own right. The research revealed three primary dimensions of pools: “staff & service”, “pool environment” and “quality of pool”, alongside “overall impression”, each comprising multiple attributes. The results show that guests were the most satisfied with the quality of “staff and service” and the least satisfied with the “ambiance” (an attribute of the “pool environment”) and with the “quality of the pool”. These results have meaningful implications for hotel management practices and facility design considerations in the luxury hospitality sector

Identifying the Main Motivations to Visit Salt Mines: Do Socio-Demographic Variables Matter?

Identifying the Main Motivations to Visit Salt Mines: Do Socio-Demographic Variables Matter? Salt has been extracted from mines in Europe for thousands of years. More recently, some of these salt mines reinvented themselves as new tourism objectives attracting hundreds of thousands and even millions of visitors each year. This research aims to investigate the main reasons tourists visit a former salt mine, focusing on Turda Salt Mine, in Romania, as a case study. The study found that the main motivations for visiting the former salt mine were leisure/relaxation, learning, adventure, to try something new and to escape the daily routine whereas participation in various cultural/religious and sport events as well as socialization with like-minded people were considered the least important motivations. The results also show that some socio-demographic factors could influence motivation to visit a salt mine. The findings of this research have a number of practical implications for the marketing and management of salt mines which are outlined at the end of the paper

Virtual Reality in Destination Marketing: The Why, The Who and The When

Virtual reality (VR) is one of the fastest growing areas in information and communication technologies. Starting with the 1990s, the technology has also been successfully employed in tourism. Among other purposes, VR is used in tourism to provide a more effective marketing of a destination than classical means such as (paper) brochures. While the literature on the use of VR in destination marketing has been steadily growing, it is still scarce and fragmented. The main objective of this study is to better understand how could VR be used to improve the marketing of tourism destinations. To gather data for this study an experiment was used: participants were invited to take an online virtual tour of a very popular landmark in Paris, and then fill out a questionnaire in order to share their experience. The data from the 89 questionnaires collected were then processed using SPSS. The results have shown that almost all of our respondents were satisfied with their VR experience. Moreover, the VR experiment has improved the users’ image of and satisfaction with the destination. This, in turn, has positively influenced their intention to visit or re-visit the destination and to recommend it to others. The study also found that some socio-demographic groups (female, older than 25 years) may be more suitable targets for destination marketing using VR than others. Finally, we learned that, although the use of VR is effective for destination marketing both before and after tourists visit the site, the technology may be more useful in improving the image of the destination when applied before the physical visit