PURPOSE: Immunogenicity is a major reason for secondary loss of response to infliximab (IFX). Recent work suggested potentially lower immunogenicity of subcutaneous (SC) compared to intravenous (IV) IFX. However, it is unknown whether re-exposure to IFX SC after secondary loss of response and immunogenicity to its intravenous formulation is safe and effective. METHODS: In a retrospective cohort study conducted at two medical centers, patients with clinically (Harvey-Bradshaw Index ≥ 5) and/or biochemically (fecal calprotectin > 250 µg/g) active Crohn's disease (CD) and previous immunogenic failure of IFX IV underwent exposure to IFX SC. Harvey-Bradshaw Index, fecal calprotectin, IFX serum concentration, and anti-drug antibodies were assessed until month 12. RESULTS: Twenty CD patients were included. The majority of patients (90%) had previous treatment with three or more biologics. Fifteen (75%) and ten (50%) of 20 patients continued IFX SC treatment until months 6 and 12, respectively. No immediate hypersensitivity reactions were observed. Two patients discontinued IFX SC treatment because of delayed hypersensitivity at week 2 and week 4. IFX serum concentrations increased from baseline to month 12, while anti-drug antibody levels decreased. Combined clinical and biochemical remission at month 12 was observed in seven of 20 patients (35%). CONCLUSION: Subcutaneous infliximab treatment of Crohn's disease patients with previous immunogenic failure of intravenous infliximab was well tolerated and effective in a cohort of patients with refractory Crohn's disease.

• Klíčová slova
• CT-P13, Immunogenic failure, Refractory Crohn’s disease, Subcutaneous infliximab,
• MeSH
• Crohnova nemoc * farmakoterapie   imunologie   MeSH
• dospělí MeSH
• feces chemie   MeSH
• infliximab * terapeutické užití   imunologie   aplikace a dávkování   MeSH
• injekce subkutánní MeSH
• intravenózní podání MeSH
• leukocytární L1-antigenní komplex analýza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• neúspěšná terapie MeSH
• retrospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• infliximab * MeSH
• leukocytární L1-antigenní komplex MeSH

BACKGROUND: Experimental evidence has revealed that phosphodiesterase five inhibitors (PDE5is) increase epithelial barrier function and suppress intestinal carcinogenesis. Few epidemiological studies have investigated the role of PDE5i in increasing the risk of colorectal cancer (CRC); however, these studies have proffered varying conclusions. We therefore aimed to perform a comprehensive review and meta-analysis to investigate whether PDE5i use is associated with the incidence of CRC. METHODS: Databases, namely, PubMed, Scopus, Embase, and Web of Science, were used for literature search. Observational studies (published until January 31, 2021) that assessed the association of PDE5i use with CRC incidence were considered. Pooled relative risk (RR) estimates and corresponding 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model. RESULTS: We identified four retrospective studies that involved 965,044 participants and 3,518 CRC cases detected during a mean follow-up of 12.7 years. Pooled results indicated a significantly reduced CRC risk among all PDE5i users (RR, 0.85; 95% CI, 0.76-0.95; P = 0.004, I2 = 63%). Moreover, continuous use of PDE5i was associated with a significantly reduced risk of CRC (RR, 0.63; 95% CI, 0.59-0.68; P < 0.001, I2 = 0.0%). However, the type of PDE5i exhibited no association with the risk of CRC (RR, 1.00; 95% CI, 0.98-1.02; I2 = 84.7%). CONCLUSION: Our findings suggest that continuous use of PDE5i was associated with a significantly reduced risk of CRC development. Future studies with a longitudinal design and adequate control of confounding factors are required to clarify whether a longer duration of PDE5i use alters the risk of CRC.

• Klíčová slova
• Colorectal cancer, Meta-analysis, Pharmacoepidemiology, Phosphodiesterase five inhibitors, Risk, Sildenafil,
• MeSH
• incidence MeSH
• inhibitory fosfodiesterasy 5 * MeSH
• kolorektální nádory * epidemiologie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• riziko MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH
• Názvy látek
• inhibitory fosfodiesterasy 5 * MeSH

PURPOSE: Crohn's disease (CD) belongs to chronic disorders with unpredictable disease course. The aim of this study was to identify how genetic testing (NOD2/CARD15) can be used in patients with CD to predict the need for surgical treatment (to define an aggressive type of disease where the patient can profit from early surgery). METHODS: The patients who were tested genetically had undergone a surgery due to CD at the Department of Surgery University Hospital Brno Bohunice between 2010 and 2016. The control group consisted of patients with CD who had been diagnosed with CD at least 5 years prior to the testing and had not required any surgical intervention. The second control group was healthy subjects. RESULTS: In total, there were 117 operated patients for CD, 77 patients with CD that had not undergone surgery for CD and 30 healthy subjects. For patients with at least one genetic mutation, the risk of the necessity of surgical treatment of CD is 1.96 times higher than for patients with no mutation. Patients with two or more mutations were generally operated on at a younger age, in a shorter time after being diagnosed and each patient had a partial resection of the ileum. CONCLUSION: The group of operated patients with CD had a significantly higher distribution of at least one genetic mutation as opposed to the non-operated group. In patients with two or more mutations, the disease course was more aggressive. This group of patients might profit from the conservative top-down or early surgical therapy.

• Klíčová slova
• Crohn’s disease, Czech cohort, Disease course, Genetics, Inflammatory bowel disease, Intestinal resection, NOD2/CARD15, Surgery,
• MeSH
• alely MeSH
• Crohnova nemoc genetika   chirurgie   MeSH
• dospělí MeSH
• genetická predispozice k nemoci MeSH
• genetické asociační studie MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mutace genetika   MeSH
• prognóza MeSH
• rizikové faktory MeSH
• signální adaptorový protein Nod2 genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• NOD2 protein, human MeSH Prohlížeč
• signální adaptorový protein Nod2 MeSH

AIM: Foreshortened mesentery or thick abdominal wall constitutes a rationale for laparoscopic intracorporeal ileocolic anastomoses (ICA). The aim of this study was to compare intracorporeal to extracorporeal ICA in terms of surgical site infections in patients with Crohn's ileitis and overweight patients with right colon tumors. METHOD: This was a prospective propensity score-matched cohort study enrolling consecutive patients with Crohn's terminal ileitis and overweight patients with right colon tumors undergoing elective laparoscopic right colon resection with intracorporeal or extracorporeal ICA. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, BMI, ASA, and previous abdominal surgery. RESULTS: Overall, 453 patients were enrolled: 233 intracorporeal vs. 220 extracorporeal. Propensity score matching left 195 intracorporeal and 195 extracorporeal patients comparable for age (p = 0.294), gender (p = 0.683), ASA (p = 0.545), BMI (p = 0.079), previous abdominal surgery (p = 0.348), and diagnosis (p = 0.301). Conversion rates (5.1 vs. 3.6%; p = 0.457) and intraoperative complications (1 vs. 2.1%; p = 0.45) were similar. Overall morbidity (5.1 vs. 12.8%; p = 0.008) and re-intervention rates (3.1 vs. 8.7%; p = 0.029) were significantly higher in extracorporeal patients. Anastomotic leak rates (0.5 vs. 1.5%; p = 0.623) did not differ. Incisional SSI rate was significantly higher in extracorporeal patients (p = 0.01). CONCLUSION: Laparoscopic intracorporeal ICA reduced incisional SSI rates as compared to its extracorporeal counterpart.

• Klíčová slova
• Extracorporeal anastomosis, Ileocolic anastomosis, Intracorporeal anastomosis, Laparoscopic right colectomy, Surgical site infection,
• MeSH
• anastomóza chirurgická škodlivé účinky   MeSH
• ileum chirurgie   MeSH
• infekce chirurgické rány epidemiologie   prevence a kontrola   MeSH
• kohortové studie MeSH
• kolon chirurgie   MeSH
• laparoskopie * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perioperační péče MeSH
• pooperační komplikace etiologie   MeSH
• tendenční skóre * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

PURPOSE: The purpose of this study is to compare the efficacy and tolerability of polyethylene glycol (PEG) to sodium picosulfate/magnesium citrate (SPMC) and low-volume polyethylene glycol/ascorbic acid (PEGA) in a single- or split-dose regimen for colonoscopy bowel preparation. METHODS: This was a prospective, randomized, endoscopist-blinded, multicentre study. Outpatients received either PEG or SPMC or PEGA in a single or a split dose before the colonoscopy. Quality and tolerability of the preparation and complaints during preparation were recorded. RESULTS: Nine hundred seventy-three patients were analysed. Satisfactory bowel cleansing (Aronchick score 1 + 2) was more frequent when a split dose was used irrespective of the solution type (PEG 90.1 vs 68.8%, PEGA 86.0 vs 71.6%, SPMC 84.3 vs 60.2%, p < 0.001). SPMC was the best tolerated followed by PEGA (p < 0.006) and PEG as the worst (p < 0.001). Tolerability did not correlate with the regimen and amount of the solution used. Female gender is associated with a higher incidence of nausea, vomiting and pain (p < 0.029). CONCLUSIONS: Both PEG, PEGA and SPMC are fully comparable in terms of colonic cleansing when used in similar regimens. The split-dose preparation is more effective in all agents. SPMC and PEGA are better tolerated than PEG. The preparation regimen and/or the volume do not affect tolerability.

• Klíčová slova
• Ascorbic acid, Colonoscopy, Magnesium citrate, Picosulfate sodium, Polyethylene glycol,
• MeSH
• citráty aplikace a dávkování   škodlivé účinky   MeSH
• kolonoskopie * MeSH
• kyselina askorbová aplikace a dávkování   škodlivé účinky   MeSH
• kyselina citronová aplikace a dávkování   škodlivé účinky   MeSH
• léčebná irigace škodlivé účinky   metody   MeSH
• lidé MeSH
• organokovové sloučeniny aplikace a dávkování   škodlivé účinky   MeSH
• pikoliny aplikace a dávkování   škodlivé účinky   MeSH
• polyethylenglykoly aplikace a dávkování   škodlivé účinky   MeSH
• projímadla aplikace a dávkování   škodlivé účinky   MeSH
• prospektivní studie MeSH
• purgativa aplikace a dávkování   škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• citráty MeSH
• kyselina askorbová MeSH
• kyselina citronová MeSH
• magnesium citrate MeSH Prohlížeč
• MoviPrep MeSH Prohlížeč
• organokovové sloučeniny MeSH
• picosulfate sodium MeSH Prohlížeč
• pikoliny MeSH
• polyethylenglykoly MeSH
• projímadla MeSH
• purgativa MeSH

• MeSH
• akutní bolest břicha komplikace   MeSH
• Crohnova nemoc komplikace   MeSH
• dospělí MeSH
• komplikace těhotenství patologie   MeSH
• lidé MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH

PURPOSE: MicroRNA-21 (miR-21) is one of the miRNAs that are frequently and highly overexpressed in tumor tissue of colorectal cancer (CRC) patients; however, only a little is known about its functional role in CRC. METHODS: We examined the expression level of miR-21 in 44 paired samples of tumoral and non-tumoral colon tissues diagnosed for CRC using TaqMan real-time PCR method. Furthermore, we used miR-21 inhibitor (anti-miR-21) to transient knockdown of miR-21 in DLD-1 colon cancer cells and examined the effects of miR-21 silencing on viability, apoptosis, chemosensitivity, cell cycle, and migration of DLD1 cells. RESULTS: The expression levels of miR-21 were significantly increased in CRC tumor tissue (P < 0.0001). Significant differences in miR-21 levels were observed also between CRC tissues of patients with CRC in different clinical stages: I vs. II (P = 0.033) and I vs. IV (P = 0.021). Kaplan-Meier analysis proved that the miR-21 expression levels are correlated to shorter overall survival of CRC patients (P = 0.0341). MiR-21 silencing in DLD1 cell line had no effect on the cell viability; however, when combined with chemotherapeutics (5-FU, L-OHP, and SN38), it contributed to the decrease of cell viability. Suppression of miR-21 decreased cell migration ability of DLD-1 cells by nearly 30 % (P = 0.016). CONCLUSION: We have confirmed the overexpression of miR-21 in CRC samples and its correlation with advanced disease and shorter overall survival. These findings could be described in part by the fact that CRC cells with increased expression of miR-21 have higher migration ability.

• MeSH
• apoptóza účinky léků   genetika   MeSH
• buněčný cyklus účinky léků   genetika   MeSH
• Kaplanův-Meierův odhad MeSH
• kolorektální nádory farmakoterapie   genetika   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikro RNA antagonisté a inhibitory   genetika   metabolismus   MeSH
• nádorové buněčné linie MeSH
• nádory tračníku genetika   patologie   MeSH
• pohyb buněk účinky léků   genetika   MeSH
• protinádorové látky farmakologie   terapeutické užití   MeSH
• regulace genové exprese u nádorů účinky léků   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• viabilita buněk účinky léků   genetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• mikro RNA MeSH
• MIRN21 microRNA, human MeSH Prohlížeč
• protinádorové látky MeSH

PURPOSE: The aim of this study was to determine whether overactivity of the anal sphincter in patients with hemorhhoids is primary or secondary and thus assess indication of lateral internal sphincterotomy to surgical treatment of hemorrhoids. Tonic contraction of the sphincter muscle in patients with advanced stages of hemorrhoids is considered by many authors as a primary cause, and therefore, they complete hemorrhoid surgery with lateral internal sphincteroomy. If hypertension of anal sphincter is secondary during hemorrhoid disease, lateral internal sphincterotomy is not indicated. Although examinations made immediately after sphincterotomy proved no changes of anal continence, certain sequelae of lateral internal sphincterotomy cannot be excluded and may later negatively affect patient's anal continence. PATIENTS AND METHODS: The prospective study comprised 385 patients treated in 2002-2006 by Hemoron or surgery according to Milligan-Morgan or Longo. Patients with history of another disease of the anal canal, radiotherapy of pelvis, Crohn's disease or ulcerous colitis were excluded. Manometry was performed before and after surgery at intervals of 1, 3, 6 and 12 months after operation using a perfusion flow method, six-channels catheter with radial arrangement of channel tips. RESULTS: In all three groups (Hemoron, sec. Milligan-Morgan, sec. Longo), there were 60-65% of patients with third degree hemorrhoids. Normal resting anal pressure before surgery was recorded in only 25% of men and 30% of women. Patients with advanced hemorrhoid degrees were found to have significant hypertension of the anal sphincter. The most significantly improved state of sphincter overactivity was observed after surgery according to Longo and application of Hemoron. After surgery, according to Milligan-Morgan, recovery of anal sphincter tension was the longest; even 6 months after operation, a mean increased resting anal pressure persisted (91-110 mmHg) in 25% of men and 19% of women. After 12 months, recovery of anal tension occurred in this group also--mean increased anal pressure was recorded in only three patients (1.67%). CONCLUSION: Overactivity of the anal sphincter in patients with hemorrhoids is secondary and according to our results. Hypertension of the sphincter muscle in patients with hemorrhoids is significantly increased in patients with advanced degrees of hemorrhoids. Therefore, it is not recommended to postpone surgery and indicate patients with advanced degrees of hemorrhoids to hemorrhoidectomy.

• MeSH
• anální kanál patofyziologie   chirurgie   MeSH
• časové faktory MeSH
• chirurgie trávicího traktu * škodlivé účinky   MeSH
• fekální inkontinence etiologie   patofyziologie   MeSH
• hemoroidy komplikace   patofyziologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• manometrie MeSH
• obnova funkce MeSH
• prospektivní studie MeSH
• rektum patofyziologie   MeSH
• stupeň závažnosti nemoci MeSH
• svalová kontrakce * MeSH
• tlak MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

BACKGROUND: Genetic variability in obesity-related genes and the resulting phenotypes are being recognized as major risk factors for colorectal cancer and/or severity of the disease. MATERIALS AND METHODS: A total of 102 patients (aged 68 +/- 10.2 years, 79 men and 23 women) and 101 age-matched (68.1 +/- 5.4 years old) individuals without colorectal cancer, 59 men and 42 women, were recruited. All the individuals were genotyped for the following subset of polymorphisms in obesity-related genes: angiotensinogen gene (M235T and -6A/G), in IL-6 gene (-174 G/C and -596 A/G), in leptin gene (-2548 A/G), and polymorphism Gln223Arg within the leptin receptor (LEPR) gene. RESULTS: A significant increase in frequency of double heterozygote genotype (MTAG) of both angiotensinogen polymorphisms in males with colorectal cancer was observed when compared to control men [odds ratio (OR) = 3.77, P (corr) = 0.001]. A marginally significant difference in genotype distribution of -174 G/C IL-6 polymorphism between the patients in stage I-II compared to patients in III-IV was found (P (g) = 0.05, P (a) = 0.173). The GG genotype of -174 G/C IL-6 polymorphism in the patients in stage III-IV carries an increased risk compared to those in stage I-II (OR = 2.83, P (corr) = 0.06). Similarly, a difference in genotype distribution of Gln223Arg in LEPR gene between the patients staged I-II compared to III-IV was observed (P (g) = 0.05). The AA genotype was shown to be risky for the patients staged III-IV (OR = 3.35, P (corr) = 0.06). CONCLUSIONS: The investigated single nucleotide polymorphisms within the genes encoding for obesity-related genes were observed to be associated both with clinical manifestation of colorectal cancer and with severity of the disease. Thus, we suggest that defined genetic variability in the genes might become DNA markers for colorectal cancer in the future.

• MeSH
• angiotensinogen genetika   MeSH
• běloši genetika   MeSH
• fenotyp MeSH
• genetická predispozice k nemoci MeSH
• genotyp MeSH
• interleukin-6 genetika   MeSH
• jednonukleotidový polymorfismus genetika   MeSH
• kolorektální nádory komplikace   genetika   MeSH
• leptin genetika   MeSH
• leptinové receptory genetika   MeSH
• lidé MeSH
• obezita komplikace   genetika   MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• angiotensinogen MeSH
• interleukin-6 MeSH
• leptin MeSH
• leptinové receptory MeSH

The first case of an adenocarcinoma developing in the retained anal canal mucosa (transitional zone) after restorative proctocolectomy with a stapled ileal pouch anal anastomosis is presented. The cancer was detected during routine follow-up 16 months after pouch formation for long standing ulcerative colitis, complicated by a cancer in the upper rectum. The patient was treated with an abdominoperineal excision of the ileal pouch and anus.

• MeSH
• adenokarcinom etiologie   MeSH
• anální kanál chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory anu etiologie   MeSH
• nádory rekta komplikace   chirurgie   MeSH
• proktokolektomie rekonstrukční * MeSH
• střevní sliznice chirurgie   MeSH
• ulcerózní kolitida komplikace   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH