Cieľ: Porovnať zmeny v cirkulácii v dolnom segmentne maternice pomocou trojdimenzionálneho power Dopplerovho ultrazvuku (3DPD) u pacientok po cisárskom reze (SC) a po nekomplikovanom vaginálnom pôrode (VAG). Materiál/metódy: Ultrazvukové vyšetrenie podstúpilo 60 pacientok po SC a 60 pacientok po vaginálnom pôrode, ktoré boli hospitalizované na Gynekologicko-pôrodníckej klinike, Jesseniovej lekárskej fakulty v Martine, Univerzity Komenského v Bratislave a Univerzitnej nemocnici v Martine od novembra 2021 do februára 2023. Pomocou 3DPD zobrazenia bol získaný vopred daný objem, a to 15 cm 3 . Ultrazvukový softvér VOCAL (Virtual Organ Computer-aided Analysis) následne automaticky kalkuloval 3 vaskulárne indexy: index vaskularizácie (VI), index prietoku (FI) a kombináciu oboch spomenutých indexov (VFI). Následne bol vyšetrený index pulzatility (PI) v oboch uterinných artériách (UtA). Všetky merania boli realizované 48 hodín po pôrode. Výsledky: V tejto pilotnej štúdii sme pozorovali signifikantné rozdiely vo všetkých troch vaskulárnych indexoch medzi skupinou pacientok po SC a po vaginálnom pôrode s p ˂ 0,001. V skupine pacientok po vaginálom pôrode sme zaznamenali inverznú koreláciu medzi vaskulárnymi indexami a hodnotami PI v UtA s p ˂ 0,001. Podobný výsledok sme však v skupine pacientok po SC nepozorovali. Záver: V súčasnosti predstavujú cirkulačné zmeny maternice v puerpériu stále pomerne málo preštudovanú problematiku. Naše výsledky dokázali signifikantné rozdiely vo vaskulárnych indexoch medzi oboma skupinami. V budúcnosti by mohla táto metodika slúžiť na monitorovanie hojenia jazvy alebo jej výslednej kvality zhojenia. Podľa súčasného prehľadu literatúry doteraz nebola publikovaná žiadna podobná štúdia.
Objective: To evaluate circulation of the lower uterine segment (LUS) using three-dimensional power Doppler ultrasound (3DPD) in patients after Cesarean section (CS) and uncomplicated vaginal delivery (VD). Study design: We evaluated 60 patients after CS and 60 patients after uncomplicated VD by ultrasound admitted at the Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Slovakia, from November 2021 to February 2023. A spherical volume of 15 cc was captured for each patient with a 3D transabdominal probe. We used an ultrasound software program Virtual Organ Computer-aided Analysis (VOCAL) to calculate three vascular indices – vascularization index (VI), flow index (FI), and vascularization-flow index (VFI). We also assessed Doppler indices in the uterine arteries (UtA). The measurements were taken 48 hours postpartum. Results: There was a significant difference in all three vascular indices between the studied and controlled group with a p-value ˂ 0.001. We observed a significant inverse correlation between vascular indices and pulsatility index (PI) in UtA in the VD group, but we found no such correlation in the CS group. Conclusion: Although it is still not well understood, 3DPD can be a suitable ultrasound method to study postpartum uterine circulation. Our results proved significant differences in vascularization and perfusion in LUS in patients after CS vs. VD. Therefore, 3DPD may be useful in the ultrasound assessment of healing areas after CS. To the best of our knowledge, this is the first study analyzing vascular indices in LUS during puerperium in patients both after VD and CS.
Significant limitations of the reactive medical approach in breast cancer management are clearly reflected by alarming statistics recorded worldwide. According to the WHO updates, breast malignancies become the leading cancer type. Further, the portion of premenopausal breast cancer cases is permanently increasing and demonstrates particularly aggressive patterns and poor outcomes exemplified by young patients with triple-negative breast cancer that lacks targeted therapy. Accumulating studies suggest the crucial role of stem cells in tumour biology, high metastatic activity, and therapy resistance of aggressive breast cancer. Therefore, targeting breast cancer stem cells is a promising treatment approach in secondary and tertiary breast cancer care. To this end, naturally occurring substances demonstrate high potential to target cancer stem cells which, however, require in-depth analysis to identify effective anti-cancer agents for cost-effective breast cancer management. The current article highlights the properties of flavonoids particularly relevant for targeting breast cancer stem cells to mitigate therapy resistance. The proposed approach is conformed with the principles of 3P medicine by applying predictive diagnostics, patient stratification and treatments tailored to the individualised patient profile. Expected impacts are very high, namely, to overcome limitations of reactive medical services improving individual outcomes and the healthcare economy in breast cancer management. Relevant clinical applications are exemplified in the paper.
- Publikační typ
- systematický přehled MeSH
BACKGROUND: Cancer management faces multiple obstacles, including resistance to current therapeutic approaches. In the face of challenging microenvironments, cancer cells adapt metabolically to maintain their supply of energy and precursor molecules for biosynthesis and thus sustain rapid proliferation and tumor growth. Among the various metabolic adaptations observed in cancer cells, the altered glucose metabolism is the most widely studied. The aberrant glycolytic modification in cancer cells has been associated with rapid cell division, tumor growth, cancer progression, and drug resistance. The higher rates of glycolysis in cancer cells, as a hallmark of cancer progression, is modulated by the transcription factor hypoxia inducible factor 1 alpha (HIF-1α), a downstream target of the PI3K/Akt signaling, the most deregulated pathway in cancer. AIM OF REVIEW: We provide a detailed overview of current, primarily experimental, evidence on the potential effectiveness of flavonoids to combat aberrant glycolysis-induced resistance of cancer cells to conventional and targeted therapies. The manuscript focuses primarily on flavonoids reducing cancer resistance via affecting PI3K/Akt, HIF-1α (as the transcription factor critical for glucose metabolism of cancer cells that is regulated by PI3K/Akt pathway), and key glycolytic mediators downstream of PI3K/Akt/HIF-1α signaling (glucose transporters and key glycolytic enzymes). KEY SCIENTIFIC CONCEPTS OF REVIEW: The working hypothesis of the manuscript proposes HIF-1α - the transcription factor critical for glucose metabolism of cancer cells regulated by PI3K/Akt pathway as an attractive target for application of flavonoids to mitigate cancer resistance. Phytochemicals represent a source of promising substances for cancer management applicable to primary, secondary, and tertiary care. However, accurate patient stratification and individualized patient profiling represent crucial steps in the paradigm shift from reactive to predictive, preventive, and personalized medicine (PPPM / 3PM). The article is focused on targeting molecular patterns by natural substances and provides evidence-based recommendations for the 3PM relevant implementation.
- MeSH
- flavonoidy MeSH
- fosfatidylinositol-3-kinasy metabolismus MeSH
- glukosa metabolismus MeSH
- individualizovaná medicína MeSH
- lidé MeSH
- nádorové mikroprostředí MeSH
- nádory * farmakoterapie metabolismus MeSH
- protoonkogenní proteiny c-akt * metabolismus MeSH
- signální transdukce MeSH
- transkripční faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- biologická terapie metody MeSH
- geny erbB-2 MeSH
- imunohistochemie MeSH
- lidé MeSH
- mamografie MeSH
- monoklonální protilátky aplikace a dávkování terapeutické užití MeSH
- nádory prsu * diagnóza genetika patologie terapie MeSH
- protinádorové látky terapeutické užití MeSH
- protokoly protinádorové léčby MeSH
- receptor erbB-2 antagonisté a inhibitory MeSH
- ultrasonografie prsů MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
Thromboembolism is the third leading vascular disease, with a high annual incidence of 1 to 2 cases per 1000 individuals within the general population. The broader term venous thromboembolism generally refers to deep vein thrombosis, pulmonary embolism, and/or a combination of both. Therefore, thromboembolism can affect both - the central and peripheral veins. Arterial thromboembolism causes systemic ischemia by disturbing blood flow and oxygen supply to organs, tissues, and cells causing, therefore, apoptosis and/or necrosis in the affected tissues. Currently applied antithrombotic drugs used, e.g. to protect affected individuals against ischemic stroke, demonstrate significant limitations. For example, platelet inhibitors possess only moderate efficacy. On the other hand, thrombolytics and anticoagulants significantly increase hemorrhage. Contextually, new approaches are extensively under consideration to develop next-generation antithrombotics with improved efficacy and more personalized and targeted application. To this end, phytochemicals show potent antithrombotic efficacy demonstrated in numerous in vitro, ex vivo, and in vivo models as well as in clinical evaluations conducted on healthy individuals and persons at high risk of thrombotic events, such as pregnant women (primary care), cancer, and COVID-19-affected patients (secondary and tertiary care). Here, we hypothesized that specific antithrombotic and antiplatelet effects of plant-derived compounds might be of great clinical utility in primary, secondary, and tertiary care. To increase the efficacy, precise patient stratification based on predictive diagnostics is essential for targeted protection and treatments tailored to the person in the framework of 3P medicine. Contextually, this paper aims at critical review toward the involvement of specific classes of phytochemicals in antiplatelet and anticoagulation adapted to clinical needs. The paper exemplifies selected plant-derived drugs, plant extracts, and whole plant foods/herbs demonstrating their specific antithrombotic, antiplatelet, and fibrinolytic activities relevant for primary, secondary, and tertiary care. One of the examples considered is antithrombotic and antiplatelet protection specifically relevant for COVID-19-affected patient groups.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Hypertensive disorders in pregnancy represent severe complications of pregnancy, which, if not treated, can result in serious health consequences for the mother and the child. Flavonoids are bioactive secondary metabolites commonly found in fruits, vegetables, green tea, whole grains, and medicinal plants. Flavonoids exert potent protective efficacy in experimental models of hypertensive disorders in pregnancy, especially preeclampsia, demonstrated through their capacity to modulate inflammatory responses, oxidative stress, and vascular dysfunction. In addition to their potential as therapeutics, flavonoids or flavonoid-rich food could be helpful to decrease the risk of hypertensive disorders in pregnancy when included in the diet pattern before and during pregnancy. However, the clinical evaluation of the potential capacity of flavonoids in hypertensive disorders in pregnancy is insufficient. Due to promising results from experimental studies, we highlight the need for the evaluation of flavonoids also in an appropriate clinical setting, which can be, together with proper preventive strategies, helpful in the overall management of hypertensive disorders in pregnancy.
- MeSH
- čaj MeSH
- dítě MeSH
- flavonoidy farmakologie terapeutické užití MeSH
- hypertenze indukovaná těhotenstvím * farmakoterapie MeSH
- lidé MeSH
- preeklampsie * farmakoterapie prevence a kontrola MeSH
- těhotenství MeSH
- zelenina MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Breast cancer incidence is actually the highest one among all cancers. Overall breast cancer management is associated with challenges considering risk assessment and predictive diagnostics, targeted prevention of metastatic disease, appropriate treatment options, and cost-effectiveness of approaches applied. Accumulated research evidence indicates promising anti-cancer effects of phytochemicals protecting cells against malignant transformation, inhibiting carcinogenesis and metastatic spread, supporting immune system and increasing effectiveness of conventional anti-cancer therapies, among others. Molecular and sub-/cellular mechanisms are highly complex affecting several pathways considered potent targets for advanced diagnostics and cost-effective treatments. Demonstrated anti-cancer affects, therefore, are clinically relevant for improving individual outcomes and might be applicable to the primary (protection against initial cancer development), secondary (protection against potential metastatic disease development), and tertiary (towards cascading complications) care. However, a detailed data analysis is essential to adapt treatment algorithms to individuals' and patients' needs. Consequently, advanced concepts of patient stratification, predictive diagnostics, targeted prevention, and treatments tailored to the individualized patient profile are instrumental for the cost-effective application of natural anti-cancer substances to improve overall breast cancer management benefiting affected individuals and the society at large.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Úvod: Karcinóm krčka maternice (CC) je štvrtým najčastejším nádorovým ochorením v populácii žien. V procese karcinogenézy tohto ochorenia zohrávajú okrem HPV významnú úlohu aj ďalšie faktory ako miRNA. Práve tieto molekuly sa javia ako možné biomarkery nádorového ochorenia krčka maternice. Metodológia: V databáze PubMed sme vyhľadali práce uverejnené v anglickom jazyku publikované v časovom horizonte rokov 2014 až 2021. Články boli vyhľadané podľa kľúčových slov: (“miR-21” [Title/Abstract]), (“miRNA-21” [Title/Abstract]), (“microRNA-21” [Title/Abstract]), (“cervical cancer” [Title/Abstract]), (“biomarker” [Title/Abstract]). Podľa kľúčových slov bol vytvorený prehľad 35 prác, pričom 2 práce demonštrovali tzv. overexpresiu miR-21 pri postihnutí inými malignitami ako CC a dve práce popisovali možné použitie nových nástrojov na identifikáciu miR-21. Šesť prehľadových prác bolo vyradených a zvyšných 25 článkov sme starostlivo študovali. Výsledok: Celkovo bolo odobratých 367 vzoriek tkaniva CC, 45 cerviko-vaginálnych laváží a 25 krvných vzoriek odobratých od pacientok s potvrdeným CC. Vo všetkých vzorkách bola potvrdená overexpresia miR-21. Dvanásť prác, okrem potvrdenia úlohy miR-21 v procese cervikálnej karcinogenézy, tiež popisovalo úlohu tejto miRNA v procese šírenia metastáz do lymfatických uzlín a vzniku rezistencie na chemorádioterapiu. Záver: Preukázaná zvýšená miera expresie miR-21 u pacientok s nádorovým ochorením krčka maternice a rozpoznanie signálnych dráh ovplyvnených touto molekulou, poukazuje na možnosť použitia miR-21 ako vhodného, neinvazívneho markera karcinómu krčka maternice.
Background: Cervical cancer (CC) is the fourth most common cancer in women. Except for HPV, other factors as miRNAs play an important role in carcinogenesis. There were found specific patterns of miRNA, which make them possible tumor biomarkers of CC. Methods: We searched for studies published in the English language in the PubMed database from 2014 to 2021. The following medical subject headings were used: (“miR-21” [Title/Abstract]), (“miRNA-21” [Title/Abstract]), (“microRNA-21” [Title/Abstract]), (“cervical cancer” [Title/Abstract]), (“biomarker” [Title/Abstract]). Only studies that were published as full-text journal articles were used and carefully checked. According to keywords, 35 studies were reviewed. Among them, 2 studies demonstrated overexpression of miR-21 also in other malignancies, and 2 studies described new potential tools for identifying miR-21 as a cancer biomarker. Six review studies were excluded. The last 25 works were reviewed. Results: Totally, in all articles in our table, it was taken 367 samples of CC tissue samples, 45 cervicovaginal lavages, and 25 blood samples in patients with confirmed CC. In all samples of patients with CC, overexpression of miR-21 was confirmed. We reviewed 12 other studies that confirm the role of miR-21 in the development of cervical lesions, but also in the spread of lymph node metastasis and chemoradiotherapy resistance. Conclusion: Demonstrated overexpression of miR-21 in CC cells and recognizing the signaling pathways affected by this molecule suggests using the miR-21 as a suitable non-invasive biomarker of CC.
Úvod: Karcinóm krčka maternice (CC) je štvrtým najčastejším nádorovým ochorením v populácii žien. V procese karcinogenézy tohto ochorenia zohrávajú okrem HPV významnú úlohu aj ďalšie faktory ako miRNA. Práve tieto molekuly sa javia ako možné biomarkery nádorového ochorenia krčka maternice. Metodológia: V databáze PubMed sme vyhľadali práce uverejnené v anglickom jazyku publikované v časovom horizonte rokov 2014 až 2021. Články boli vyhľadané podľa kľúčových slov: (“miR-21” [Title/Abstract]), (“miRNA-21” [Title/Abstract]), (“microRNA-21” [Title/Abstract]), (“cervical cancer” [Title/Abstract]), (“biomarker” [Title/Abstract]). Podľa kľúčových slov bol vytvorený prehľad 35 prác, pričom 2 práce demonštrovali tzv. overexpresiu miR-21 pri postihnutí inými malignitami ako CC a dve práce popisovali možné použitie nových nástrojov na identifikáciu miR-21. Šesť prehľadových prác bolo vyradených a zvyšných 25 článkov sme starostlivo študovali. Výsledok: Celkovo bolo odobratých 367 vzoriek tkaniva CC, 45 cerviko-vaginálnych laváží a 25 krvných vzoriek odobratých od pacientok s potvrdeným CC. Vo všetkých vzorkách bola potvrdená overexpresia miR-21. Dvanásť prác, okrem potvrdenia úlohy miR-21 v procese cervikálnej karcinogenézy, tiež popisovalo úlohu tejto miRNA v procese šírenia metastáz do lymfatických uzlín a vzniku rezistencie na chemorádioterapiu. Záver: Preukázaná zvýšená miera expresie miR-21 u pacientok s nádorovým ochorením krčka maternice a rozpoznanie signálnych dráh ovplyvnených touto molekulou, poukazuje na možnosť použitia miR-21 ako vhodného, neinvazívneho markera karcinómu krčka maternice.
Background: Cervical cancer (CC) is the fourth most common cancer in women. Except for HPV, other factors as miRNAs play an important role in carcinogenesis. There were found specific patterns of miRNA, which make them possible tumor biomarkers of CC. Methods: We searched for studies published in the English language in the PubMed database from 2014 to 2021. The following medical subject headings were used: (“miR-21” [Title/Abstract]), (“miRNA-21” [Title/ Abstract]), (“microRNA-21” [Title/Abstract]), (“cervical cancer” [Title/Abstract]), (“biomarker” [Title/Abstract]). Only studies that were published as full-text journal articles were used and carefully checked. According to keywords, 35 studies were reviewed. Among them, 2 studies demonstrated overexpression of miR-21 also in other malignancies, and 2 studies described new potential tools for identifying miR-21 as a cancer biomarker. Six review studies were excluded. The last 25 works were reviewed. Results: Totally, in all articles in our table, it was taken 367 samples of CC tissue samples, 45 cervicovaginal lavages, and 25 blood samples in patients with confirmed CC. In all samples of patients with CC, overexpression of miR-21 was confirmed. We reviewed 12 other studies that confirm the role of miR-21 in the development of cervical lesions, but also in the spread of lymph node metastasis and chemoradiotherapy resistance. Conclusion: Demonstrated overexpression of miR-21 in CC cells and recognizing the signaling pathways affected by this molecule suggests using the miR-21 as a suitable non-invasive biomarker of CC.
AIMS: Coronavirus disease 2019 is responsible for a worldwide increase in morbidity and mortality. The relationship of this infection to mother-to-child vertical transmission has not been elucidated yet. However, recent reports indicate a foetal death rate of up to 3%. METHODS: We report a case of sudden pre-term foetal demise in a woman positive for SARS-CoV-2 but asymptomatic, with physiological course of pregnancy. RESULTS: One of the possible explanations of sudden foetal death may be acute placental insufficiency caused by a SARS-CoV-2 placental infection or the development of foetal inflammatory response syndrome (FIRS). CONCLUSION: Considering the potential risk of foetal demise, questions remain regarding foetal monitoring and the timing of labour and delivery in the second and third trimesters, particularly in asymptomatic or mild maternal SARS-CoV-2 infection. A relevant multidisciplinary team must also be aware of these risks associated with possibly fatal consequences.
- MeSH
- COVID-19 virologie MeSH
- dospělí MeSH
- infekční komplikace v těhotenství virologie MeSH
- lidé MeSH
- odumření plodu * MeSH
- placenta virologie MeSH
- SARS-CoV-2 izolace a purifikace MeSH
- těhotenství MeSH
- vertikální přenos infekce MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
