Východiska: Zhoubné nádory jater jsou agresivní a mají špatnou prognózu přežití. Metalothionein (MT) je nízkomolekulární intracelulární protein, jehož primární funkcí je udržení homeostázy těžkých kovů v živých organizmech. Molekulární mechanizmus exprese MT je velmi málo prostudován. Nedávné výzkumy ukazují na jeho významný vztah ke karcinogenezi, spontánní mutagenezi a účinnosti protinádorových léčiv. Již v předchozích studiích bylo dokázáno, že hladiny MT stoupají u nádorového onemocnění. Cílem naší práce bylo studium MT za účelem zvýšení efektivity diagnostiky zhoubných nádorů jater. Metody: V pilotní studii (2022–2023) byla sledována skupina 15 pacientů s hepatocelulárním karcinomem (hepatocellular carcinoma – HCC, diagnóza C220) a skupina 15 pacientů s hepatoblastomem (diagnóza C222). Kontrolní skupina byla vybrána ze zdravých probandů (n = 20). Pro analýzu byla použita námi vyvinutá modifikovaná metoda. Vzorky krevních sér probandů byly tepelně denaturovány (99 ̊C, 20 min). MT byl stanoven pomocí elektrochemie. Získaná data byla uložena a zpracována v laboratorním informačním systému QINSLAB. Výsledky: U vzorků denaturovaných krevních sér byly získány voltametrické křivky MT. Stanovením plochy pod křivkou (area under the curve – AUC) byly vypočteny koncentrace MT. Pro porovnání normální a abnormální hladiny MT byla použita kontrolní séra zdravých probandů (n = 20) se zjištěným průměrným množstvím MT 2,0 ± 1,3 μg/l a mediánem 1,9 μg/l. U skupiny pacientů s HCC bylo zjištěno průměrné množství MT 9,1 ± 6,5 μg/l a medián 9,0 μg/l. Tzv. receiver operating characteristic (ROC) analýza ukázala AUC 0,864 (95% CI 0,736–0,992), senzitivitu 0,74 a specificitu 0,75. U pacientů s hepatoblastomem bylo zjištěno průměrné množství MT 11,5 ± 7,5 μg/l a medián 10,9 μg/l. ROC analýza ukázala AUC 0,868 (95% CI 0,751–0,993), senzitivitu 0,84 a specificitu 0,86. V korelační analýze byla pozorována korelace MT ke karcinoembryonálnímu antigenu (CEA) (r = 0,99), kyselině močové (r = −0,86) a iontům draslíku (r = −0,94). Závěr: V této pilotní studii se podařilo sledovat pravděpodobnou asociaci hladiny MT u probandů se zhoubnými nádory jater. Z publikovaných prací je známo, že hladiny MT jsou dlouhodobě zvýšené a předpokládáme, že souvisí se zvýšenou metabolickou aktivitou nádorových buněk. Studie bude dále pokračovat na větším souboru pacientů.
Background: Malignant liver tumors are highly aggressive with a poor prognosis. Metalothionein (MT) is a low-molecular intracellular protein, whose primary function is to regulate the homeostasis of heavy metals in many organisms. There are only few studies focusing on the molecular mechanisms of MT expression. Recent studies show its significant relations to carcinogenesis, spontaneous mutagenesis and efficiency of antitumor medicine. In previous studies, the increase of MT levels in cancer patients was proven. The aim of this work is to study MT as well as to increase the efficiency of malignant liver tumor diagnosis. Methods: In our pilot study (2022–2023) we observed a group of 15 patients with hepatocellular carcinoma (diagnosis C220) and a group of 15 patients with hepatoblastoma (diagnosis C222). The control group included 20 healthy probands. We developed our own modified method for the analysis. Blood serum samples of the probands were denaturated (99 ̊C, 20 min). MT was determined by an electrochemical method. Obtained data were stored and processed in the laboratory information system QINSLAB. Results: In denaturated blood serum samples, we obtained voltametric curves of MT. We determined concentrations of MT by evaluating the area under the curve (AUC). To differentiate normal and abnormal concentrations of MT, blood samples of healthy probands were used (N = 20), with the average MT levels of 2.0 ± 1.3 μg/L and median 1.9 μg/L. In patients diagnosed with HCC, the average MT levels were 9.1 ± 6.5 μg/L and median 9.0 μg/L. The receiver operating characteristic (ROC) analysis showed AUC 0.864 (95% CI 0.736–0.992), sensitivity 0.74 and specificity 0.75. In patients diagnosed with hepatoblastoma, the average MT concentrations measured were 11.5 ± 7.5 μg/L and the median was 10.9 μg/L. The ROC analysis displayed AUC 0.868 (95% CI 0.751–0.993), sensitivity 0.84 and specificity 0.86. The correlation analysis showed correlation between MT and carcinoembryonic antigen (CEA) (r = 0.99), uric acid (r = −0.86) and potassium ions (r = −0.94). Conclusion: In this pilot study, we observed the association of MT levels in healthy probands and malignant liver tumor patients. Many previous studies show that MT concentrations are increasing as the illness progresses. We assume that this increase is connected to the high metabolic activity of cancer cells. This study will continue with collecting a larger number of samples.
- MeSH
- elektrochemické techniky klasifikace metody MeSH
- hepatoblastom krev patologie MeSH
- hepatocelulární karcinom krev patologie MeSH
- lidé MeSH
- metalothionein * analýza krev MeSH
- nádorové biomarkery analýza krev MeSH
- nádory jater * diagnóza farmakoterapie krev MeSH
- pilotní projekty MeSH
- prognóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
Previous studies have shown that the cholinergic nucleus basalis of Meynert and its white matter projections are affected in Alzheimer's disease dementia and mild cognitive impairment. However, it is still unknown whether these alterations can be found in individuals with subjective cognitive decline, and whether they are more pronounced than changes found in conventional brain volumetric measurements. To address these questions, we investigated microstructural alterations of two major cholinergic pathways in individuals along the Alzheimer's disease continuum using an in vivo model of the human cholinergic system based on neuroimaging. We included 402 participants (52 Alzheimer's disease, 66 mild cognitive impairment, 172 subjective cognitive decline and 112 healthy controls) from the Deutsches Zentrum für Neurodegenerative Erkrankungen Longitudinal Cognitive Impairment and Dementia Study. We modelled the cholinergic white matter pathways with an enhanced diffusion neuroimaging pipeline that included probabilistic fibre-tracking methods and prior anatomical knowledge. The integrity of the cholinergic white matter pathways was compared between stages of the Alzheimer's disease continuum, in the whole cohort and in a CSF amyloid-beta stratified subsample. The discriminative power of the integrity of the pathways was compared to the conventional volumetric measures of hippocampus and nucleus basalis of Meynert, using a receiver operating characteristics analysis. A multivariate model was used to investigate the role of these pathways in relation to cognitive performance. We found that the integrity of the cholinergic white matter pathways was significantly reduced in all stages of the Alzheimer's disease continuum, including individuals with subjective cognitive decline. The differences involved posterior cholinergic white matter in the subjective cognitive decline stage and extended to anterior frontal white matter in mild cognitive impairment and Alzheimer's disease dementia stages. Both cholinergic pathways and conventional volumetric measures showed higher predictive power in the more advanced stages of the disease, i.e. mild cognitive impairment and Alzheimer's disease dementia. In contrast, the integrity of cholinergic pathways was more informative in distinguishing subjective cognitive decline from healthy controls, as compared with the volumetric measures. The multivariate model revealed a moderate contribution of the cholinergic white matter pathways but not of volumetric measures towards memory tests in the subjective cognitive decline and mild cognitive impairment stages. In conclusion, we demonstrated that cholinergic white matter pathways are altered already in subjective cognitive decline individuals, preceding the more widespread alterations found in mild cognitive impairment and Alzheimer's disease. The integrity of the cholinergic pathways identified the early stages of Alzheimer's disease better than conventional volumetric measures such as hippocampal volume or volume of cholinergic nucleus basalis of Meynert.
- MeSH
- Alzheimerova nemoc * psychologie MeSH
- bílá hmota * MeSH
- cholinergní látky MeSH
- kognitivní dysfunkce * psychologie MeSH
- lidé MeSH
- mozek MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Metalothionein (MT) je nízkomolekulární intracelulární protein, jehož primární funkcí je udržení homeostázy těžkých kovů v živých organismech. Molekulární mechanismus exprese MT je velmi málo prostudován. Nedávné výzkumy ukazují na jeho významný vztah ke karcinogenezi, spontánní mutagenezi a účinnosti protinádorových léčiv. Zvýšená hladina MT je studována jako potenciální ukazatel zvýšené metabolické aktivity u nádorových onemocnění. Elektrochemické metody jsou vhodným analytickým nástrojem pro detekci MT. Za využití elektrochemické analýzy (Brdičkovy reakce) byly studovány teplotně denaturované vzorky krevních sér pacientů s diagnostikovaným nádorovým onemocněním. Získané voltamogramy byly vyhodnoceny jako plocha pod křivkou (AUC odpověď). Pro porovnání normální a abnormální hladiny MT bylo použito kontrolní sérum zdravých probandů (n = 38) s průměrným množstvím MT 2,2 μg l–1 a mediánem 2,1 μg l–1. Ve všech hodnocených vzorcích krevních sér pacientů s nádorovým onemocněním (n = 228) bylo průměrné množství MT 22,7 μg l–1 a medián 18,1 μg l–1. Rozdíl (10násobný) mezi skupinami byl statisticky vysoce významný. Získaná data pilotního experimentu naznačují, že hladiny thiolových sloučenin, jako je MT, mohou mít u pacientů s nádorovým onemocněním klinický potenciál.
Metallothionein (MT) is a low molecular weight intracellular protein, the primary function of which is to maintain the homeostasis of heavy metals in living organisms. Only a few research has been carried on the topic molecular mechanism of MT. Recent research points to its significant relationship to carcinogenesis, spontaneous mutagenesis, and the effectiveness of antitumor drugs. Increased level of MT is studied as a potential indicator of increased metabolic activity in cancer. Electrochemical methods are a suitable analytical tool for MT detection. Temperature-denatured blood serum samples of patients diagnosed with cancer were studied using electrochemical analysis (Brdička's reaction). The obtained voltammograms were evaluated as the area under the curve (AUC response). To compare normal and abnormal MT levels, control serum of healthy probands (n = 38) with an average MT amount of 2.2 μg L–1, median 2.1 μg L–1 was used. In all evaluated blood serum samples of cancer patients (n = 228), the average amount of MT was 22.7 μg L–1, and the median was 18.1 μg L–1. The difference (10-fold) between groups was highly statistically significant. The data obtained from the pilot experiment suggest that the levels of thiol compounds such as MT may have clinical potential in cancer patients.
Cíl studie: V pilotním experimentu analyzovat metalothioneinu (MT) ve vzorcích moči pacientů se zhoubným nádorem prostaty (CaP). Metody: Vzorky byly analyzovány elektrochemicky metodou diferenční pulzní voltametrie (DPV) vBrdičkově základním elektrolytu. Získaná data byla vyhodnocena jako plochy pod křivkou (AUC). Koncentrace MT bylyvyhodnoceny metodou kalibrační křivky. Výsledky: Metallothioneiny jsou proteiny o molekulové hmotnosti kolem 10kDa. Jejich biologická role je především v udržování homeostázy iontů kovů v organismech. Analytické stanovení je komplikované. Mezi nejvhodnější metody patří elektrochemie. Uvedené metodické přístupy jsme aplikovali nasledování změn obsahu MT u pacientů s CaP a zbytnělou prostatou. V pilotním experimentu jsme zjistili, že průměrnáhladina MTu: a) kontrolní skupiny (n = 13) byla 2,9 ± 1,2 μg/mmol kreatininu; b) benigní hyperplazie prostaty 4,7 ± 1,7 μg/mmol kreatininu; c) CaP skupina (n = 9) 6,7 ± 1,5 μg/mmol kreatininu. Rozdíl mezi kontrolní skupinou a skupinouCaP byl statisticky průkazný (p = 0,0099). Mezi benigní hyperplazií prostaty a CaP byl také prokázán rozdíl (p =0,0928). Signály u pacientů s benigní hyperplazií prostaty (BHP) nevykazují statisticky významný rozdíl proti kontrolnískupině (p = 0,7869). Závěr: Získané prvotní výsledky naznačují, že hladiny MT lze v moči stanovit elektrochemicky. Mezi testovanými skupinami se podařilo prokázat rozdíly. Hladiny MT u pacientů s CaP byly zvýšené, ale musejí být dále detailněji studovány.
Aim: To analyse concentrations of metallothionein (MT) in urine samples of patients diagnosed with prostate cancer (CaP). Methods: Samples were electrochemically analysed by difference pulse voltametry (DPV) method in Brdička’s buffer. Acquired data were then evaluated as an area under the curve (AUC). Concentrations of MT were determinedby calibration curve method. Results: Metallothioneins are proteins with molecular weight about 10 kDa. Theirbiological significance lies in maintaining homeostasis of metal ions. Their analytical determination is complicated. One of the most effective determination methods is by electrochemistry. Previously mentioned methods were used tostudy the changes of MT concentrations of patients with CaP, and with benign prostate hyperplazia (BHP). Our pilotexperiment determined concentrations of MT in a) healthy controls (n = 13) was 2.9 ± 1.2 μg/mmol of creatinine, b) BHP was 4.7 ± 1.7 μg/mmol of creatinine, c) CaP group (n = 9) was 6.7 ± 1.5 μg/mmolof creatinine. Difference between healthy controls and CaP group was statistically significant (p = 0.0099). Differencebetween BHP and CaP group was also determined (p = 0.0928). Difference between BHP and healthy controls is notvery statistically significant (p = 0.7869). Conclusion: We were able to demonstrate differences between healthycontrols, BHP patients and CaP patients.Concentrations of MT in CaP patients were elevated, but they need to be studied in more detail.
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND AND OBJECTIVES: Several pathologic processes might contribute to the degeneration of the cholinergic system in aging. We aimed to determine the contribution of amyloid, tau, and cerebrovascular biomarkers toward the degeneration of cholinergic white matter (WM) projections in cognitively unimpaired individuals. METHODS: The contribution of amyloid and tau pathology was assessed through CSF levels of the Aβ42/40 ratio and phosphorylated tau (p-tau). CSF Aβ38 levels were also measured. Cerebrovascular pathology was assessed using automatic segmentations of WM lesions (WMLs) on MRI. Cholinergic WM projections (i.e., cingulum and external capsule pathways) were modeled using tractography based on diffusion tensor imaging data. Sex and APOE ε4 carriership were also included in the analysis as variables of interest. RESULTS: We included 203 cognitively unimpaired individuals from the H70 Gothenburg Birth Cohort Studies (all individuals aged 70 years, 51% female). WM lesion burden was the most important contributor to the degeneration of both cholinergic pathways (increase in mean square error [IncMSE] = 98.8% in the external capsule pathway and IncMSE = 93.3% in the cingulum pathway). Levels of Aβ38 and p-tau also contributed to cholinergic WM degeneration, especially in the external capsule pathway (IncMSE = 28.4% and IncMSE = 23.4%, respectively). The Aβ42/40 ratio did not contribute notably to the models (IncMSE<3.0%). APOE ε4 carriers showed poorer integrity in the cingulum pathway (IncMSE = 21.33%). Women showed poorer integrity of the external capsule pathway (IncMSE = 21.55%), which was independent of amyloid status as reflected by the nonsignificant differences in integrity when comparing amyloid-positive vs amyloid-negative women participants (T201 = -1.55; p = 0.123). DISCUSSION: In cognitively unimpaired older individuals, WMLs play a central role in the degeneration of cholinergic pathways. Our findings highlight the importance of WM lesion burden in the elderly population, which should be considered in the development of prevention programs for neurodegeneration and cognitive impairment.
- MeSH
- Alzheimerova nemoc * diagnostické zobrazování genetika metabolismus MeSH
- amyloid metabolismus MeSH
- amyloidní beta-protein metabolismus MeSH
- amyloidogenní proteiny metabolismus MeSH
- amyloidóza * MeSH
- apolipoprotein E4 genetika MeSH
- bílá hmota * patologie MeSH
- biologické markery MeSH
- cholinergní látky MeSH
- lidé MeSH
- proteiny tau metabolismus MeSH
- senioři MeSH
- zobrazování difuzních tenzorů MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective. METHODS: An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added. RESULTS: Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes. CONCLUSIONS: EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.
- MeSH
- demence * MeSH
- elektronické zdravotní záznamy * MeSH
- kvalita života MeSH
- lidé MeSH
- pečovatelské domovy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
The integrity of the cholinergic system plays a central role in cognitive decline both in normal aging and neurological disorders including Alzheimer's disease and vascular cognitive impairment. Most of the previous neuroimaging research has focused on the integrity of the cholinergic basal forebrain, or its sub-region the nucleus basalis of Meynert (NBM). Tractography using diffusion tensor imaging data may enable modelling of the NBM white matter projections. We investigated the contribution of NBM volume, NBM white matter projections, small vessel disease (SVD), and age to performance in attention and memory in 262 cognitively normal individuals (39-77 years of age, 53% female). We developed a multimodal MRI pipeline for NBM segmentation and diffusion-based tracking of NBM white matter projections, and computed white matter hypointensities (WM-hypo) as a marker of SVD. We successfully tracked pathways that closely resemble the spatial layout of the cholinergic system as seen in previous post-mortem and DTI tractography studies. We found that high WM-hypo load was associated with older age, male sex, and lower performance in attention and memory. A high WM-hypo load was also associated with lower integrity of the cholinergic system above and beyond the effect of age. In a multivariate model, age and integrity of NBM white matter projections were stronger contributors than WM-hypo load and NBM volume to performance in attention and memory. We conclude that the integrity of NBM white matter projections plays a fundamental role in cognitive aging. This and other modern neuroimaging methods offer new opportunities to re-evaluate the cholinergic hypothesis of cognitive aging.
- MeSH
- bílá hmota anatomie a histologie diagnostické zobrazování MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervové dráhy anatomie a histologie diagnostické zobrazování MeSH
- nucleus basalis Meynerti anatomie a histologie diagnostické zobrazování MeSH
- paměť fyziologie MeSH
- pars basalis telencephali anatomie a histologie diagnostické zobrazování MeSH
- pozornost fyziologie MeSH
- senioři MeSH
- sexuální faktory MeSH
- stárnutí fyziologie MeSH
- věkové faktory MeSH
- zobrazování difuzních tenzorů * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Objective: The electronic patient record (EPR) has been introduced into nursing homes with the aim of reducing time spent on documentation, improving documentation quality and increasing transferability of information, all of which should facilitate care provision. However, previous research has shown that EPR may be creating new burdens for staff. The purpose of this literature review is to explore how EPR is facilitating or hindering care provision in nursing homes. Methods: An integrative literature review was carried out using four electronic databases to search for relevant articles. After screening, 22 articles were included for thematic synthesis. Results: Thematic synthesis resulted in six analytical themes linked to care provision: time for direct care; accountability; assessment and care planning; exchange of information; risk awareness; and person-centered care. Conclusion: For EPR to facilitate care provision in nursing homes, consideration should be given to the type of device used for documentation, as well as the types of applications, the functionality, content, and structure of EPR. Further research exploring the experiences of end users is required to identify the optimal characteristics of an EPR system specifically for use in nursing homes.
