INTRODUCTION: Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published an update on the Global Strategy for Prevention, Diagnosis and Management of COPD, introducing a new classification of chronic obstructive pulmonary disease (COPD). Our aim was to assess the prognostic value of the new GOLD classification system in comparison with the previous GOLD classification systems (GOLD stages I-IV and GOLD groups A-D) and the BODE index. METHODS: We used the data of 784 patients with COPD from the Czech Multicenter Research Database of COPD. Patient survival was analyzed with the use of Kaplan-Meier estimate and Cox model of proportional risks. ROC analysis and area under curve (AUC) were used for comparison of GOLD classifications and BODE index. The analyses were performed with the use of software R (version 4.2.0). RESULTS: We analyzed data of 782 patients with complete data on GOLD classifications. The study population comprised 72.9% of men, 89.1% current or former smokers, with a mean age of 66.6 years, a mean BMI of 27.4 and a mean FEV1 44.9% of predicted. Probability of 5-year survival differed by GOLD classification. Application of the 2023 GOLD classification showed increased risk of death in group B (HR 1.82, 95% CI 1.14-2.92; p = 0.013) and in group E (HR 2.48, 95% CI 1.54-3.99; p˂0.001). The ROC analysis showed that the overall prognostic value of the 2023 GOLD classification was similarly weak to previous A-D GOLD classification schemes (AUCs 0.557-0.576) and was lower compared to the GOLD 1-4 system (AUC 0.614) and even lower when compared to the BODE index (AUC 0.715). CONCLUSION: We concluded that the new GOLD classification system has poor prognostic properties and that specific prediction tools (eg, the BODE index) should be used for mortality risk assessment.
- MeSH
- chronická obstrukční plicní nemoc * diagnóza terapie MeSH
- hodnocení rizik MeSH
- lidé MeSH
- prognóza MeSH
- progrese nemoci MeSH
- proporcionální rizikové modely MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Úvod: V našem příspěvku chceme připomenout vzácnou diagnózu. Kazuistika: 54letý pacient, obézní hypertonik a kuřák, byl 12 let ošetřován pro intermitentní bolesti břicha. První gastroskopii pro krvácející vřed absolvoval v r. 2010. V dalších letech následovaly opakované gastroskopie s proměnlivým postižením jícnu až duodena. Kapslová enteroskopie diagnostiku dále neposunula. Pacient několikrát podstoupil koloskopii a MR enterografii, jednoznačně patologický nález nepřinesly. V květnu 2022 byl přijat na naše oddělení pro bolesti břicha, zvracení. Tentokrát na gastroskopii byly patrné mnohočetné drobné ulcerace duodena a jejuna s koaguly, která činila mechanickou překážku. Pro podezření na gastrinom byl doplněn chromogranin A, který byl vysoký. Somatostatinový octreoscan byl však negativní. Až 68Ga-DOTATOC PET (pozititronová emisní tomografie s radiofarmakem DOTA, značeným galiem68) nalezl ložisko v podjaterní krajině, které ale nemělo žádný korelát na CT. Diagnózu jsme uzavřeli jako gastrinom s Zollinger-Ellisonovým syndromem. Endoskopicky se podařilo nalézt asi 1cm tumor duodena. Pacient v říjnu 2022 podstoupil excizi stěny duodena. Patolog potvrdil naši diagnózu gastrinomu. Závěr: Touto kazuistikou chceme připomenout, že i neuroendokrinní tumory musíme zařadit do našich diferenciálně diagnostických úvah. Současně chceme upozornit, že dle ESMO doporučení bychom měli k diagnostice preferenčně využívat 68Ga-DOTATOC PET/CT místo scintigrafického vyšetření (111In-Octreoscanu).
Introduction: In our text, we want to highlight a rare diagnosis. Case report: A 54-year-old obese, hypertensive male smoker had been investigated for intermittent abdominal pain for 12 years. The first gastroscopy for a bleeding ulcer was conducted in 2010. In the subsequent years, repeated gastroscopies revealed variable involvement from the esophagus to the duodenum. Capsule enteroscopy did not provide further specification of the diagnosis. The patient underwent colonoscopy and MRI enterography multiple times, with no unequivocal pathological findings. In May 2022, he was admitted to our department for abdominal pain and vomiting. This time, gastroscopy revealed multiple small ulcers in the duodenum and jejunum with clots causing a mechanical obstruction. Chromogranin A was elevated, raising suspicion of gastrinoma. However, somatostatin receptor-based imaging (Octreoscan) was negative. Only the 68Ga-DOTATOC PET (positron emission tomography with the radiopharmaceutical DOTA, labeled with gallium-68) identified a lesion in the subhepatic region, which had no correlation on CT. We concluded the diagnosis as gastrinoma with the Zollinger–Ellison syndrome. Endoscopically, a 1cm tumor was found in the duodenum. In October 2022, the patient underwent an excision of the duodenal wall, and the pathology assessment confirmed our diagnosis of gastrinoma. Conclusion: With this case report, we want to emphasize the importance of taking into account neuroendocrine tumors in our differential diagnostic considerations. At the same time, we want to highlight that, according to ESMO recommendations, we should preferentially use 68Ga-DOTATOC PET/CT for the diagnosis instead of scintigraphic examination (111In-Octreoscan).
- MeSH
- bolesti břicha etiologie MeSH
- chromogranin A analýza MeSH
- gastrinom * chirurgie diagnostické zobrazování patologie MeSH
- gastriny analýza MeSH
- inhibitory protonové pumpy terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory duodena * chirurgie diagnostické zobrazování patologie MeSH
- neuroendokrinní nádory chirurgie diagnostické zobrazování klasifikace patologie MeSH
- PET/CT metody MeSH
- Zollingerův-Ellisonův syndrom diagnóza etiologie patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
Background: Adherence to inhaled medication constitutes a major problem in patients with chronic obstructive pulmonary disease (COPD) globally. However, large studies evaluating adherence in its entirety and capturing a large variety of potentially associated factors are still lacking. Objective: To study both elementary types of adherence to chronic inhaled COPD medication in "real-life" COPD patients and to assess relationships with a wide-ranging spectrum of clinical parameters. Methods: Data from the Czech Multicentre Research Database (CMRD) of COPD, an observational prospective study, were used. Overall adherence (OA) was evaluated with Morisky Medication Adherence Scale (©MMAS-4) and adherence to an application technique (A-ApplT) with the Five Steps Assessment. Mann-Whitney U test, Spearman's correlation, and logistic regression were used to explore relationships between variables. Results: Data of 546 participants (69.6% of all patients from the CMRD) were analyzed. Two-thirds self-reported optimal OA, but only less than one-third demonstrated A-ApplT without any error. OA did not correlate with A-ApplT. Next, better OA was associated with higher education, a higher number of inhalers, a lower rate of exacerbations, poorer lung function, higher degree of upper respiratory tract symptoms (SNOT-22), absence of depressive symptoms, ex-smoking status, regular mouthwash after inhaled corticosteroids (ICS), and flu vaccination. By contrast, better A-ApplT was associated with a lower number of inhalers, better lung function, and regular mouthwash after ICS. Independent predictors of nonoptimal OA included lower degree of education, absence of flu vaccination, anemia, depression, and peptic ulcer history, whereas independent predictors of lower A-ApplT were lower education, absence of regular mouthwash after ICS, and higher COPD Assessment Test score. Conclusions: Parameters associated with OA and A-ApplT differ, and those associated with both adherence domains are sometimes associated inversely. Based on this finding, we understand these as two separate constructs with an overlap.
- Publikační typ
- časopisecké články MeSH
Autoři v příspěvku poukazují na možnosti využití dvou přístrojů 3D scaneru a ultrazvukového vyšetření v praxi fyzioterapeuta. Na příkladu pacientky po distorzi kolenního kloubu, u níž přetrvával i po prodělaných opakovaných artroskopických operacích a absolvované, vč. stále probíhající rehabilitace, omezený rozsah kolenního kloubu, který by v daném časovém horizontu měl být již upraven, demonstrují jednoduchost a přínos těchto nových metod, které se jeví vhodným doplňkem při vyšetřovacích postupech v oblasti rehabilitace.
The authors point out the possibilities of using two devices – a 3D scanner and ultrasound examination in the practice of a physiotherapist. They present a case study of a patient after knee joint distortion with limited extension of the knee joint persisting after repeated arthroscopic operations and ongoing rehabilitation although the time of treatment should normally be sufficient for resolving the problem, and demonstrate the simplicity and benefits of these new methods, which seem to be a suitable complement to assessment procedures used in rehabilitation.
- Klíčová slova
- 3D scaner,
- MeSH
- artroskopie MeSH
- dospělí MeSH
- kolenní kloub * patologie MeSH
- lidé MeSH
- rehabilitace * přístrojové vybavení MeSH
- ultrasonografie MeSH
- výsledek terapie MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Introduction: The concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: "Czech" COPD phenotypes and their most frequent combinations, "Spanish" phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk. Methods: Data were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary "Czech" phenotypes and their most frequent and relevant combinations, "Spanish" phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test. Results: The cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV1 44.4% pred. KM estimates showed bronchiectases/COPD overlap (HR 1.425, p=0.045), frequent exacerbator (HR 1.58, p<0.001), cachexia (HR 2.262, p<0.001) and emphysematous (HR 1.786, p=0.015) phenotypes associated with higher mortality risk. Co-presence of multiple phenotypes in a single patient had additive effect on risk; combination of emphysema, cachexia and frequent exacerbations translated into poorest prognosis (HR 3.075; p<0.001). Of the "Spanish" phenotypes, AE CB and AE non-CB were associated with greater risk of mortality (HR 1.787 and 2.001; both p=0.001). FEV1% pred., cachexia and chronic heart failure in patient history were the major underlying factors determining mortality risk in our cohort. Conclusion: Certain phenotypes ("Czech" or "Spanish") of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.
- MeSH
- chronická bronchitida * MeSH
- chronická obstrukční plicní nemoc * diagnóza MeSH
- fenotyp MeSH
- lidé MeSH
- progrese nemoci MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Španělsko MeSH
The Schistura robertsi species complex is a group of freshwater fish inhabiting streams in southeast Myanmar as well as in western and southern Thailand. In southern Thailand, the distribution exceeds the biogeographically important 'Surat Thani - Krabi line'. The complex is believed to include five described and one undescribed species, but monophyly and systematics of the group have never been studied explicitly. The present study aims to resolve the number of species within the Schistura robertsi group as well as their distribution areas and phylogenetic relations. We analysed mitochondrial and nuclear sequence data of 86 specimens from 47 localities and 18 morphological characters of 193 specimens. The phylogenetic analyses revealed the S. robertsi complex to be monophyletic and to be composed of ten major lineages. Six of them correspond to the known described or undescribed species, but another four newly identified clades reveal the existence of an overlooked diversity within the group. All genetic lineages are statistically highly supported and all are morphologically diagnosable, suggesting that they represent distinct species. The distribution areas of several clades overlap, the cases of direct co-occurrence show no sign of hybridisation.
- MeSH
- Bayesova věta MeSH
- biodiverzita * MeSH
- časové faktory MeSH
- druhová specificita MeSH
- fylogeneze MeSH
- kalibrace MeSH
- máloostní anatomie a histologie klasifikace MeSH
- zeměpis MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Myanmar MeSH
- Thajsko MeSH
Western Southeast Asia is hosting one of the world's most diverse faunas, and one of the reasons for this huge diversity is the complex geologic past of the area, increasing the frequency of isolation and expansion events over evolutionary time scale. As an example case, the present study reveals the phylogeny and biogeographic history of the Paracanthocobitis zonalternans species complex, small benthic freshwater fish (Teleostei: Nemacheilidae) that are commonly occurring across western Southeast Asia (from central Myanmar through western and southern Thailand to northern Malaysia). The group is particularly interesting since it occurs in three biogeographic subdivisions (Indian, Indochinese, Malay/Sundaic) and across all of the major biogeographic barriers in the region. Basing on mitochondrial and nuclear sequence data of 93 samples from about 50 localities we found six major clades, most with exclusive geographic distribution. Divergence time dated the origin of the P. zonalternans species complex to early Miocene (17.8 MYA) and a biogeographic analysis identified the Tenasserim region as the ancestral region. From this region the fish spread during periods of lowered global sea level, particularly during late Miocene (11-8 MYA) northwards into all Burmese river basins and southwards into south Thailand and northern Malaysia. Besides lowered global sea level periods, local stream capture events allowed the complex to expand, e.g. into the Mae Klong basin. Strong fragmentations during periods with elevated sea level during the Pliocene and Pleistocene repeatedly restricted populations to refuges and shaped the observed major lineages. Our results document a higher diversity within the P. zonalternans species complex than formerly believed and a strong impact of global sea level on its evolutionary history. Low sea levels promoted dispersal and elevated sea levels fragmentation events. A very similar impact of sea level changes can be expected in all stationary fauna (freshwater and terrestrial) in all non-mountainous coastal regions worldwide.
- MeSH
- Bayesova věta MeSH
- biodiverzita * MeSH
- časové faktory MeSH
- fylogeneze MeSH
- fylogeografie * MeSH
- máloostní fyziologie MeSH
- mitochondriální DNA genetika MeSH
- mořská voda * MeSH
- sladká voda * MeSH
- společenstvo * MeSH
- zeměpis MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- jihovýchodní Asie MeSH
