Background/Objectives: As musculoskeletal injuries in gastroenterologists related to the performance of endoscopic procedures are on the rise, solutions and new approaches are needed to prevent these undesired outcomes. In our study, we evaluated an approach to ergonomic challenges in the form of a belt-like endoscope holder designed to redistribute the weight of the endoscope across the whole body of the practitioner. The aim of the study was to determine how the use of this holder affected the body posture of practitioners during endoscopy. Methods: We designed a special endoscopic model that emulates basic endoscopic movement and maneuvers. With the use of the MoCap camera system, we recorded experienced endoscopists exercising a standardized set of tasks with and without the holder. Results: Following video and statistical analyses, the most significant differences were observed in the position of the left arm which pointed to a more relaxed arm position. Conclusions: The ergonomic benefits of the belt holder in this model merit testing in the clinical setting to evaluate its effectiveness and prevention of musculoskeletal injuries in GI endoscopy.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Faecal microbiota transplantation (FMT) is a developing therapy for disorders related to gut dysbiosis. Despite its growing application, standardised protocols for FMT filtrate preparation and quality assessment remain undeveloped. The viability of bacteria in the filtrate is crucial for FMT's efficacy and for validating protocol execution. We compared two methods-in vitro cultivation and membrane integrity assessment-for their accuracy, reproducibility and clinical applicability in measuring bacterial viability in frozen FMT stool filtrate. METHODS: Bacterial viability in stool filtrate was evaluated using (i) membrane integrity through fluorescent DNA staining with SYTO9 and propidium iodide, followed by flow cytometry and (ii) culturable bacteria counts (colony-forming units, CFU) under aerobic or anaerobic conditions. RESULTS: Using different types of samples (pure bacterial culture, stool of germ-free and conventionally bred mice, native and heat-treated human stool), we refined the bacterial DNA staining protocol integrated with flow cytometry for assessment of bacterial viability in frozen human stool samples. Both the membrane integrity-based and cultivation-based methods exhibited significant variability in bacterial viability across different FMT filtrates, without correlation. The cultivation-based method showed a mean coefficient of variance of 30.3%, ranging from 7.4% to 60.1%. Conversely, the membrane integrity approach yielded more reproducible results, with a mean coefficient of variance for viable cells of 6.4% ranging from 0.2% to 18.2%. CONCLUSION: Bacterial viability assessment in stool filtrate using the membrane integrity method offers robust and precise data, making it a suitable option for faecal material evaluation in FMT. In contrast, the cultivation-dependent methods produce inconsistent outcomes.
- MeSH
- Bacteria izolace a purifikace MeSH
- feces * mikrobiologie MeSH
- fekální transplantace * metody MeSH
- lidé MeSH
- mikrobiální viabilita * MeSH
- myši MeSH
- průtoková cytometrie * metody MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
BACKGROUND: Endoluminal radiofrequency ablation (RFA) has been promoted as palliative treatment for patients with cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC) in order to improve biliary drainage and eventually prolong survival. No high level evidence is, however, available on this technique. DESIGN: In this randomised controlled study, we compared endoluminal RFA plus stenting with stenting alone (control group) in patients with malignant biliary obstruction; metal stents were primarily placed. Primary outcome was overall survival; secondary outcomes were stent patency, quality of life and adverse events. In a superiority design, survival was assumed to be doubled by RFA as compared with 6.4 months in the control group (n=280). RESULTS: A total of 161 patients (male:female 90:71, mean age 71±9 years) were randomised before recruitment was terminated for futility after an interim analysis. Eighty-five patients had CCA (73 hilar, 12 distal) and 76 had pancreatic cancer. There was no difference in survival in both subgroups: for patients with CCA, median survival was 10.5 months (95% CI 6.7 to 18.3) in the RFA group vs 10.6 months (95% CI 9.0 to 24.8), p=0.58)) in the control group. In the subgroup with pancreatic cancer, median survival was 6.4 months (95% CI 4.3 to 9.7) for the RFA vs 7.7 months (95% CI 5.6 to 11.3), p=0.73) for the control group. No benefit was seen in the RFA group with regard to stent patency (at 12 months 40% vs 36% in CCA and 66% vs 65% in PDAC), and quality of life was unchanged by either treatment and comparable between the groups. Adverse events occurred in seven patients in each groups. CONCLUSION: A combination of endoluminal RFA and stenting was not superior to stenting alone in prolonging survival or improving stent patency in patients with malignant biliary obstruction. TRIAL REGISTRATION NUMBER: NCT03166436.
- MeSH
- cholangiokarcinom * MeSH
- cholestáza * etiologie chirurgie MeSH
- katetrizační ablace * škodlivé účinky metody MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory slinivky břišní * komplikace chirurgie MeSH
- nádory žlučových cest * komplikace chirurgie MeSH
- radiofrekvenční ablace * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenty škodlivé účinky MeSH
- výsledek terapie MeSH
- žlučové cesty intrahepatální chirurgie 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
- randomizované kontrolované studie MeSH
- Publikační typ
- abstrakt z konference MeSH
The research of novel implantable medical devices is one of the most attractive, yet complex areas in the biomedical field. The design and development of sufficiently small devices working in an in vivo environment is challenging but successful encapsulation of such devices is even more so. Industry-standard methods using glass and titanium are too expensive and tedious, and epoxy or silicone encapsulation is prone to water ingress with cable feedthroughs being the most frequent point of failure. This paper describes a universal and straightforward method for reliable encapsulation of circuit boards that achieves ISO10993 compliance. A two-part PVDF mold was machined using a conventional 3-axis machining center. Then, the circuit board with a hermetic feedthrough was placed in the mold and epoxy resin was injected into the mold under pressure to fill the cavity. Finally, the biocompatibility was further enhanced with an inert P3HT polymer coating which can be easily formulated into an ink. The biocompatibility of the encapsulants was assessed according to ISO10993. The endurance of the presented solution compared to silicone potting and epoxy potting was assessed by submersion in phosphate-buffered saline solution at 37 °C. The proposed method showed superior results to PDMS and simple epoxy potting.
Radiofrequency ablation (RFA) is a mini-invasive loco-regional ablation technique that is increasingly being used as a palliative treatment for pancreatic cancer and cholangiocarcinoma. Ablation-triggered immune system stimulation has been proposed as a mechanism behind the systemic effects of RFA. The aim of our study was to investigate the immune response to endoluminal biliary RFA. Peripheral blood samples were collected from patients with pancreatic cancer and cholangiocarcinoma randomised to receive endoluminal biliary radiofrequency ablation + stent (19 patients) or stent only (21 patients). We observed an early increase in IL-6 levels and a delayed increase in CXCL1, CXCL5, and CXCL11 levels as well as an increase in CD8+ and NK cells. However, these changes were not specific to RFA treatment. Explicitly in response to RFA, we observed a delayed increase in serum CXCL1 levels and an early decrease in the number of anti-inflammatory CD206+ blood monocytes. Our study provides the first evidence of endoluminal biliary RFA-based regulation of the systemic immune response in patients with pancreatic cancer and cholangiocarcinoma. These changes were characterised by a general inflammatory response. RFA-specific activation of the adaptive immune system was not confirmed.
- Publikační typ
- časopisecké články MeSH
- MeSH
- časové faktory MeSH
- diagnostické techniky gastrointestinální * MeSH
- endoskopie trávicího systému metody MeSH
- klinické rozhodování MeSH
- komunitní zdravotní střediska organizace a řízení MeSH
- laparoskopie metody MeSH
- lidé MeSH
- mezioborová komunikace MeSH
- nádory trávicího systému chirurgie diagnóza terapie MeSH
- nemoci trávicího systému * chirurgie diagnóza terapie MeSH
- týmová péče o pacienty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
V následující kazuistice prezentujeme případ 31letého pacienta vyšetřovaného pro podezření na nádor tenkého střeva. Nádory tenkého střeva jsou samy o sobě relativně vzácné a k definitivní diagnóze mnohdy dochází až po chirurgické resekci. Stejně tomu bylo i u našeho pacienta vyšetřovaného pro nález měkkotkáňového útvaru v oblasti tenkého střeva dle zobrazovacích vyšetření. Po vyloučení hormonální aktivity byla provedena diagnostická laparotomie. Histopatologicky byl zjištěn vzácný nádor mezenteria – desmoidní fibromatóza. Jedná se o nádor bez metastatického potenciálu se středně maligním potenciálem pro agresivní růst do okolních struktur a orgánů a velké procento lokálních recidiv.
In the following report, we present the case of a 31-year-old patient examined for a suspected small bowel tumour. Small bowel tumours are relatively rare and definitive diagnosis is often preceded by surgical resection. The same was true for our patient examined for a soft tissue lesion found with imaging techniques in close proximity to the small intestine. After ruling out hormonal activity, diagnostic laparotomy was performed. Desmoid fibromatosis, a rare tumour of the mesentery, was confirmed histopathologically. Although without metastatic potential, desmoid fibromatosis is a tumour with moderately malignant potential for aggressive growth into surrounding structures and organs and a large percentage of local recurrences.
- MeSH
- agresivní fibromatóza * chirurgie diagnostické zobrazování MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- lidé MeSH
- mezenterium chirurgie diagnostické zobrazování patologie MeSH
- střevní nádory * chirurgie diagnostické zobrazování MeSH
- tenké střevo chirurgie patologie MeSH
- vzácné nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Autoimunitní pankreatitida je specifickou formou chronického zánětlivého onemocnění slinivky břišní. Svými klinickými projevy může imitovat i maligní onemocnění pankreatu, a proto je pro stanovení diagnózy nezbytný multidisciplinární přístup. Autoimunitní pankreatitidu lze diagnostikovat na základě kombinace klinických příznaků, zobrazovacích a endoskopických metod, sérologického a v neposlední řadě histopatologického vyšetření. Klinicky a histomorfologicky existují dvě různé formy autoimunitní pankreatitidy – typ 1 a typ 2. První typ je lymfoplazmocytární sklerotizující pankreatitida a u druhého typu se jedná o idiopatickou centroduktální sklerotizující pankreatitidu. Onemocnění probíhá nejčastěji ve formě chronické pankreatitidy a akutními exacerbacemi. Autoři v tomto článku prezentují dvě kazuistiky pacientů operovaných pro podezření na maligní postižení pankreatu, u kterých až následně na základě histopatologického vyšetření byla diagnostikována autoimunitní pankreatitida. Cílem sdělení je proto poukázat na diagnostická úskalí tohoto onemocnění. Chirurgická léčba není dle současných doporučení považována za standardní léčebný postup.
Autoimmune pancreatitis is a specific type of chronic pancreatitis. Its clinical manifestation mimics pancreatic cancer. A multidisciplinary approach is necessary to establish the correct diagnosis. Autoimmune pancreatitis can be diagnosed on the basis of symptomatology, imaging methods, endoscopy, serology and histopathological examination. There are two different forms of autoimmune pancreatitis – type 1 and type 2. Type 1 is lymphoplasmacytic sclerosing pancreatitis and type 2 is idiopathic centroductal sclerosing pancreatitis. The disease most often takes a chronic form with acute exacerbations. In this paper we present two case reports of patients operated on for suspected malignancy of the pancreas, who were subsequently diagnosed with autoimmune pancreatitis based on histopathological examination. The aim of this communication is to point out the diagnostic pitfalls of this disease. Surgical treatment is not considered as a standard therapeutic method according to the current guidelines.
- MeSH
- autoimunitní tyreoiditida * chirurgie diagnóza farmakoterapie MeSH
- diagnostické zobrazování MeSH
- fatální výsledek MeSH
- imunoglobulin G krev MeSH
- lidé MeSH
- lymfadenektomie MeSH
- pankreatektomie MeSH
- prednison aplikace a dávkování terapeutické užití MeSH
- senioři MeSH
- splenektomie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The human gut microbiota consists of bacteria, archaea, fungi, and viruses. It is a dynamic ecosystem shaped by several factors that play an essential role in both healthy and diseased states of humans. A disturbance of the gut microbiota, also termed "dysbiosis", is associated with increased host susceptibility to a range of diseases. Because of splanchnic ischemia, exposure to antibiotics, and/or the underlying disease, critically ill patients loose 90% of the commensal organisms in their gut within hours after the insult. This is followed by a rapid overgrowth of potentially pathogenic and pro-inflammatory bacteria that alter metabolic, immune, and even neurocognitive functions and that turn the gut into the driver of systemic inflammation and multiorgan failure. Indeed, restoring healthy microbiota by means of fecal microbiota transplantation (FMT) in the critically ill is an attractive and plausible concept in intensive care. Nonetheless, available data from controlled studies are limited to probiotics and FMT for severe C. difficile infection or severe inflammatory bowel disease. Case series and observational trials have generated hypotheses that FMT might be feasible and safe in immunocompromised patients, refractory sepsis, or severe antibiotic-associated diarrhea in ICU. There is a burning need to test these hypotheses in randomized controlled trials powered for the determination of patient-centered outcomes.
- MeSH
- dysbióza epidemiologie mikrobiologie terapie MeSH
- feces mikrobiologie MeSH
- fekální transplantace metody MeSH
- idiopatické střevní záněty epidemiologie mikrobiologie terapie MeSH
- kritický stav epidemiologie MeSH
- lidé MeSH
- průjem epidemiologie mikrobiologie terapie MeSH
- střevní mikroflóra genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
