OBJECTIVE: Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system with varying progression rates among individuals. The ability to predict disease progression is crucial for treatment decisions with disease-modifying therapies (DMTs). A few cerebrospinal fluid (CSF) biomarkers have been investigated in relation to disease progression, but few have been effectively translated into clinical practice. The aim of this study was to evaluate the diagnostic and prognostic value of known CSF markers, to compare their sensitivity and specificity, and to develop a prognostic model using a combination of markers to predict disease progression. METHODS: This retrospective cohort study included 82 patients with a first episode of inflammatory demyelinating symptoms suggestive of MS between January 2018 and January 2021. Patients underwent diagnostic lumbar puncture and other investigations according to the multiple sclerosis (MS) protocol. They were divided into three groups according to MRI findings, relapse rate and EDSS score. CSF marker concentrations were determined by laser nephelometry and electrochemiluminescence immunoassay. RESULTS: The results showed that the number of oligoclonal bands could discriminate the progression-free group from the other groups, but had a lower discriminatory power compared to CSF marker concentrations. Among CSF markers, FLC kappa showed the best discriminatory performance. By combining FLC kappa with gender and lesion localization information, a simple predictor of progression-free group membership was proposed. This predictor showed good sensitivity (91 %) and specificity (65 %). CONCLUSION: In conclusion, CSF FLC kappa concentration, together with gender and lesion localization, may be a valuable predictor of disease progression in MS patients. This study highlights the potential of using CSF biomarkers for prognostic purposes and offers a simple approach to predicting disease progression.
Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
- MeSH
- akutní nemoc MeSH
- kožní nemoci * etiologie MeSH
- kůže MeSH
- lidé MeSH
- nádory slinivky břišní * komplikace MeSH
- nemoci slinivky břišní * komplikace patologie MeSH
- pankreatitida * etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Background: Pheochromocytoma is a neuroendocrine tumour originating from the chromaffin cells of adrenal glands or sympathetic paraganglia. It produces most frequently norepinephrine, epinephrine, and dopamine. As a result of non-specific and variable clinical presentation, pheochromocytoma is difficult to diagnose. Case summary: A 37-year-old female without medical history and 57-year-old male patient with diabetes, arterial hypertension, and aortic valve replacement with a mechanical prosthesis were admitted to the hospital after successful cardiopulmonary resuscitation due to ventricular fibrillation. In both patients, coronary angiography demonstrated a normal finding, and echocardiography showed left ventricular (LV) contractile dysfunction with improvement in the subsequent examination. In the first patient, the diagnosis of stress-induced cardiomyopathy was considered as the most probable cause. She was later admitted to hospital due to acute pulmonary oedema with hypertensive crisis. Echocardiography documented reversible LV systolic dysfunction with improvement after 3 days. The course of hospitalization of the male was complicated by multi-organ dysfunction syndrome comprising renal failure, paralytic ileus, and pancreatic irritation, which normalized after 2 weeks. The diagnosis of pheochromocytoma was confirmed by laboratory tests and imaging methods. After pharmacological pre-treatment with doxazosin in both patients and bisoprolol in the female, successful adrenalectomies were performed with no relapse of tumour. Discussion: We describe an atypical clinical presentation of pheochromocytoma with initial cardiac arrest due to ventricular fibrillation and reversible LV systolic dysfunction. Our cases underline that clinical suspicion of pheochromocytoma as a potentially correctable cause should be raised in unexplained cases of severe heart failure, ventricular arrhythmias, and cardiac arrest.
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing. METHODS: We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years. RESULTS: 82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged <60 years were more likely to be non-adherent than older patients (OR 2.15). No other clinical or laboratory parameters predicted non-adherence. CONCLUSIONS: A significant proportion of outpatients with chronic heart failure were non-adherent to treatment when assessed by a direct method of serum drug level testing. Non-adherence was more likely in younger patients.
- MeSH
- adherence k farmakoterapii statistika a číselné údaje MeSH
- antagonisté mineralokortikoidních receptorů terapeutické užití MeSH
- antagonisté receptorů pro angiotenzin terapeutické užití MeSH
- beta blokátory terapeutické užití MeSH
- chronická nemoc farmakoterapie MeSH
- inhibitory ACE terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- srdeční selhání farmakoterapie MeSH
- věkové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
AIMS: The aim of the study was to analyse the prognostic and predictive value of LC3A positive' 'Stone Like Structures'' (SLSs) in a large cohort of patients with non-small cell lung carcinoma (NSCLC) and to check its relationship with tumor infiltrating lymphocytes (TILs) and PD-L1 expression. METHODS: Tissue microarrays from 1015 patients diagnosed at the Institute of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland, were stained for LC3A, PD-L1, CD3 and CD68 using automated tissue stainer Ventana Benchmark Ultra (Roche). TILs were assessed in matched haematoxylin and eosin stained slides. RESULTS: LC3A positive SLSs, were significantly associated with worse overall (OS) and disease-free survival (DFS) outcomes in patients with lung adenocarcinoma (LADC) (HR = 2.4, 95 %CI(.994-1.008, p = 0.029) and HR = 3.9, 95 %CI (1.002-1.014), p = 0.002 respectively), whilst it was associated with better OS and DFS in patients with lung squamous cell carcinoma (LUSC), with marginal significance (HR = .99, 95 %CI(.975-1.011),p = 0.042 and HR = .99, 95 %CI (.975-1.008), p = 0.026). Multivariate analysis showed that LC3A SLSs are independent poor prognostic factor only in patients with LADC. In addition, LC3A SLSs, were negatively associated with CD68 count in LADC, whilst there was a positive correlation in LSCC. CONCLUSIONS: LC3A SLSs are differentially associated with the survival outcomes and CD68 count in LADC and LSCC. Further studies are justified for the understanding the underlying biological mechanisms of this phenomenon.
- MeSH
- adenokarcinom plic * MeSH
- antigeny CD274 MeSH
- antigeny diferenciační myelomonocytární MeSH
- CD antigeny MeSH
- lidé MeSH
- makrofágy * MeSH
- nádory plic * MeSH
- prognóza MeSH
- proteiny asociované s mikrotubuly MeSH
- spinocelulární karcinom * MeSH
- tumor infiltrující lymfocyty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Švýcarsko MeSH
BACKGROUND/AIM: LUCAS is a clinical lung cancer registry (ClinicalTrials.gov identifier is NCT04228237), prospectively collecting data from newly diagnosed lung cancer patients in seven pneumooncology centers in the Czech Republic, since June 1, 2018. The aim of the study was to assess the stage of the disease at the time of diagnosis, percentage of morphological types, survival, percentage of driving mutations, eligibility for radical surgery, and percentage of patients who undergo radical surgery, in the non-smoking population in comparison with smokers and former smokers. PATIENTS AND METHODS: The total number of patients in the registry at the time of the analysis was 2,743. Only 2,439 patients with complete records (smoking status, stage, and type of tumor) were included in this study. RESULTS: The analysis indicated that non-smokers are diagnosed at a later stage of the disease but they have a better survival rate than smokers. Fewer smokers with stage III disease who are eligible for radical surgery will undergo surgery compared to non-smokers with the same clinical stage. Driving mutations are more common in non-smokers, even after adjustment for the more frequent occurrence of adenocarcinoma in the group of non-smokers. CONCLUSION: The data from LUCAS registry are consistent with already known facts, suggesting that the LUCAS registry is a useful clinical tool.
- MeSH
- bývalí kuřáci MeSH
- časové faktory MeSH
- dospělí MeSH
- kuřáci MeSH
- lidé středního věku MeSH
- lidé MeSH
- malobuněčný karcinom plic diagnóza epidemiologie mortalita terapie MeSH
- mladý dospělý MeSH
- mutace MeSH
- nádorové biomarkery genetika MeSH
- nádory plic diagnóza epidemiologie mortalita chirurgie MeSH
- nekuřáci * MeSH
- nemalobuněčný karcinom plic diagnóza epidemiologie mortalita chirurgie MeSH
- pneumektomie MeSH
- prospektivní studie MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
Cíl: Pandemie COVID-19 zasáhla celý systém zdravotní péče. Cílem studie je zjistit dopad pandemie na oblast spánkové medicíny v ČR (CZE) a na Slovensku (SVK). Metody: Dotazníková studie 23 spánkových pracovišť (sleep departments; SD) (16 CZE; 7 SVK) v období 5.-17. 5. 2020. Výsledky: Provoz zcela přerušilo 43,5 % SD. Součet odhadů neprovedených nočních monitorací spánku v referujících pracovištích je 1 100 a součet odhadů neprovedených titrací terapie přetlakovou ventilací je 580. Vzhledem k podílu SD, které odpověděly, odhadujeme, že z důvodu COVID-19 nebylo v CZE a na SVK dohromady provedeno přibližně 1 900 nočních monitorací spánku a 1 000 titrací terapie přetlakovým dýcháním. Situace se nejspíše v nebližší době nezlepší, 59,1 % SD předpokládá nižší počet diagnostikovaných/léčených pacientů ve srovnání s rokem 2019 (53,3 % CZE; 71,4 % SVK) a k 31. 5. 2020 nebude v provozu 34.8 % SD nebo bude jejich kapacita výrazně snížena (23,5 % CZE; 57,1 % SVK). Závěr: Spánková medicína v CZE a na SVK byla těžce zasažena COVID-19 a výrazné snížení počtu diagnostických a terapeutických výkonů může být považována za jednu z "kolaterálních škod".
Aim: The COVID-19 pandemic affected all parts of the healthcare system. The aim of this study was to assess the pandemics effect on sleep medicine in the Czech Republic (CZE) and Slovakia (SVK). Methods: A questionnaire based study, in which where 23 sleep departments (SD) (16 CZE; 7 SVK) were included between May 5, 2020 and May 17, 2020. Results: The service was completely interrupted in 43.5% SD. The sum of estimated missed sleep studies in responding SD was 1,100 and the sum of missed positive airway pressure titrations was 580. When considering the response rate of the questionnaire through extrapolation, it is estimated that about 1,900 sleep studies and 1,000 positive airway pressure titrations were not performed in the region of the CZE and SVK because of COVID-19. The situation is unlikely to improve soon, as 59.1% of SD do not expect to meet the same number of diagnosed/treated patients as in 2019 (53.3% CZE; 71.4% SVK) and about 34.8% of SD will not restart their activity by the end of May 2020 or will run with a very limited capacity (23.5% CZE; 57.1% SVK). Conclusion: Sleep medicine in the CZE and SVK was heavily affected by COVID-19 and the loss of diagnostic and therapeutic procedures may be considered as one of pandemic "collateral damages".
- MeSH
- COVID-19 MeSH
- koronavirové infekce MeSH
- lidé MeSH
- obstrukční spánková apnoe MeSH
- poruchy spánku a bdění * diagnóza terapie MeSH
- poskytování zdravotní péče * statistika a číselné údaje MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
Triple-positive breast cancer (TPBC), i.e. HER2-positive (HER2+) and hormone receptors-positive breast cancer, is a specific subgroup of breast cancers. TPBC biology is characterized by strong mutual interactions between signaling pathways stimulated by estrogens and HER2 amplification. The present study aims to carry out a population-based analysis of treatment outcomes in a cohort of hormone receptor (HR) positive and negative breast cancer patients who were treated with anti-HER2 therapy in the Czech Republic. The BREAST research database was used as the data source for this retrospective analysis. The database covers approximately 95% of breast cancer patients treated with targeted therapies in the Czech Republic. The analysis included 6,122 HER2-positive patients. The patients were divided into two groups, based on estrogen receptor (ER) or progesterone receptor (PR) positivity: hormone receptor negative (HR-) patients had both ER- and PR-negative tumors (n=2,518), unlike positive (HR+) patients (n=3,604). HR+ patients were more often diagnosed premenopausal at the time of diagnosis, presented more often at stage I or II and their tumors were less commonly poorly differentiated. The overall survival (OS) was significantly higher in subgroups of HR+ patients according to treatment setting. When evaluated by stages, significantly higher OS was observed in HR+ patients diagnosed at stages II, III, and IV and regardless of tumor grade.
- MeSH
- lidé MeSH
- míra přežití MeSH
- nádorové biomarkery MeSH
- nádory prsu * farmakoterapie genetika MeSH
- prognóza MeSH
- receptor erbB-2 antagonisté a inhibitory genetika MeSH
- receptory pro estrogeny genetika MeSH
- receptory progesteronu genetika MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVES: DNA repair proteins have emerged as potential predictors for immunotherapy response alongside PD-L1 expression, tumor-infiltrating lymphocytes (TILs) and tumor mutational burden. We analyzed expression of PD-L1, TILs count and expression of the homologous recombination (HR) protein RAD51, as potential prognostic factors in patients with resected non-small-cell lung carcinoma (NSCLC). MATERIALS AND METHODS: Discovery set included 96 NSCLC patients from the University Hospital Olomouc (Czech Republic) and a replication set included 1109 NSCLC patients from University Hospital Zurich (Switzerland). Tissue microarrays (TMAs) were stained using the automated staining platform Ventana Benchmark Ultra with antibodies against RAD51,CD3, CD8, CD68 and PD-L1. RESULTS: Loss of nuclear RAD51 protein was associated with high TILs (r=-0.25, p = 0.01) and PD-L1 status (10.6 vs. 2.4 %, p = 0.012) in patients receiving neoadjuvant chemo-/radiotherapy (CT/RT). In silico analysis from the TCGA data set showed a negative relationship between RAD51 mRNA expression and CD45 (r = ‒0.422, p < 0.0001), CD68 (r = ‒0.326, p < 0.001), CD3 (r = ‒0.266, p < 0.001) and CD8 (r = ‒0.102, p < 0.001). RAD51 low/PD-L1 high patients were clustered as separate entity in the replication set and in TCGA dataset. High TILs status was significantly associated with improved OS in the replication set (unadjusted HR = 0.57, 95 % CI 0.42-0.76, p < 0.001). Similar results have been seen for CD3, CD8 and CD68. CONCLUSIONS: In conclusion, RAD51 nuclear loss is weakly associated with increased TILs and high PD-L1 at the time of surgery in curatively resected NSCLC and after prior exposure to neoadjuvant chemo- or radiotherapy. Both high TILs and RAD51 nuclear loss were confirmed as independent prognostic factors in curatively resected NSCLC.
- MeSH
- antigeny CD274 genetika MeSH
- lidé MeSH
- nádory plic * genetika terapie MeSH
- nemalobuněčný karcinom plic * genetika terapie MeSH
- oprava DNA MeSH
- prognóza MeSH
- rekombinasa Rad51 genetika MeSH
- tumor infiltrující lymfocyty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Švýcarsko MeSH
Introduction: It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem. Objective: The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters. Methods: A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests. Results: The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements. Conclusion: The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.
- Publikační typ
- časopisecké články MeSH
