Autoři prezentují případ chylózního ascitu, který vznikl po roboticky asistované retroperitoneální lymfadenektomii. Po neúspěšné konzervativní léčbě byla provedena intranodální lymfografie olejovou kontrastní látkou. Po lymfografii došlo k zástavě tvorby ascitu. Danou kazuistikou chceme poukázat na možnost léčby postoperačního chylózního

The authors present a case of chylous ascites that developed after robot-assisted retroperitoneal lymphadenectomy. The intranodal lymphography with an oil-based contrast media was performed due to unsuccessful conservative treatment. After the lymphography chylous ascites ceased. This case report shows the possibility of treating postoperative chylous ascites with a radiological mini-invasive method.

• MeSH
• chylózní ascites * etiologie   terapie   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   MeSH
• lymfatický systém diagnostické zobrazování   MeSH
• lymfografie * metody   MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• pooperační komplikace terapie   MeSH
• roboticky asistované výkony * metody   MeSH
• Check Tag
• lidé MeSH

Fibrosis contributes to tissue repair, but excessive fibrosis disrupts organ function. Alagille syndrome (ALGS, caused by mutations in JAGGED1) results in liver disease and characteristic fibrosis. Here, we show that Jag1Ndr/Ndr mice, a model for ALGS, recapitulate ALGS-like fibrosis. Single-cell RNA-seq and multi-color flow cytometry of the liver revealed immature hepatocytes and paradoxically low intrahepatic T cell infiltration despite cholestasis in Jag1Ndr/Ndr mice. Thymic and splenic regulatory T cells (Tregs) were enriched and Jag1Ndr/Ndr lymphocyte immune and fibrotic capacity was tested with adoptive transfer into Rag1-/- mice, challenged with dextran sulfate sodium (DSS) or bile duct ligation (BDL). Transplanted Jag1Ndr/Ndr lymphocytes were less inflammatory with fewer activated T cells than Jag1+/+ lymphocytes in response to DSS. Cholestasis induced by BDL in Rag1-/- mice with Jag1Ndr/Ndr lymphocytes resulted in periportal Treg accumulation and three-fold less periportal fibrosis than in Rag1-/- mice with Jag1+/+ lymphocytes. Finally, the Jag1Ndr/Ndr hepatocyte expression profile and Treg overrepresentation were corroborated in patients' liver samples. Jag1-dependent hepatic and immune defects thus interact to determine the fibrotic process in ALGS.

• MeSH
• Alagillův syndrom patologie   genetika   MeSH
• buněčná diferenciace * MeSH
• hepatocyty * metabolismus   patologie   MeSH
• jaterní cirhóza * patologie   genetika   MeSH
• lidé MeSH
• modely nemocí na zvířatech MeSH
• myši inbrední C57BL MeSH
• myši knockoutované MeSH
• myši MeSH
• protein jagged-1 * metabolismus   genetika   MeSH
• regulační T-lymfocyty imunologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Traditionally, anticancer therapies focus on restraining uncontrolled proliferation. However, these cytotoxic therapies expose cancer cells to direct killing, instigating the process of natural selection favoring survival of resistant cells that become the foundation for tumor progression and therapy failure. Recognizing this phenomenon has prompted the development of alternative therapeutic strategies. Here we propose strategies targeting cancer hallmarks beyond proliferation, aiming at re-educating cancer cells towards a less malignant phenotype. These strategies include controlling cell dormancy, transdifferentiation therapy, normalizing the cancer microenvironment, and using migrastatic therapy. Adaptive resistance to these educative strategies does not confer a direct proliferative advantage to resistant cells, as non-resistant cells are not subject to eradication, thereby delaying or preventing the development of therapy-resistant tumors.

• MeSH
• chemorezistence MeSH
• lidé MeSH
• nádorové mikroprostředí * MeSH
• nádory * terapie   MeSH
• proliferace buněk MeSH
• protinádorové látky terapeutické užití   farmakologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Notch signaling controls multiple aspects of embryonic development and adult homeostasis. Alagille syndrome is usually caused by a single mutation in the jagged canonical Notch ligand 1 (JAG1), and manifests with liver disease and cardiovascular symptoms that are a direct consequence of JAG1 haploinsufficiency. Recent insights into Jag1/Notch-controlled developmental and homeostatic processes explain how pathology develops in the hepatic and cardiovascular systems and, together with recent elucidation of mechanisms modulating liver regeneration, provide a basis for therapeutic efforts. Importantly, disease presentation can be regulated by genetic modifiers, that may also be therapeutically leverageable. Here, we summarize recent insights into how Jag1 controls processes of relevance to Alagille syndrome, focused on Jag1/Notch functions in hepatic and cardiovascular development and homeostasis.

• MeSH
• Alagillův syndrom * diagnóza   genetika   terapie   MeSH
• lidé MeSH
• membránové proteiny genetika   metabolismus   MeSH
• mezibuněčné signální peptidy a proteiny genetika   MeSH
• protein jagged-1 genetika   MeSH
• proteiny vázající vápník genetika   MeSH
• serrate-jagged proteiny MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

This article represents the first paper in a two-part series dealing with safety during tram-pedestrian collisions. This research is dedicated to the safety of trams for pedestrians during collisions and is motivated by the increased number of lethal cases. The first part of this paper includes an overview of tram face development from the earliest designs to the current ones in use and, at the same time, provides a synopsis and explanation of the technical context, including a link to current and forthcoming legislation. The historical design development can be characterised by three steps, from an almost vertical front face, to leaned and pointed shapes, to the current inclined low-edged windshield without a protruding coupler. However, since most major manufacturers now export their products worldwide and customisation is only of a technically insignificant nature, our conclusions are generalisable (supported by the example of Berlin). The most advantageous shape of the tram's front, minimising the effects on pedestrians in all collision phases, has evolved rather spontaneously and was unprompted, and it is now being built into the European Commission regulations. The goal of the second part of this paper is to conduct a series of tram-pedestrian collisions with a focus on the frontal and side impacts using a crash test dummy (anthropomorphic test device-ATD). Four tram types approaching the collision at four different impact speeds (5 km/h, 10 km/h, 15 km/h, and 20 km/h) were used. The primary outcome variable was the resultant head acceleration. The risk and severity of possible head injuries were assessed using the head injury criterion (HIC15) and its linkage to the injury level on the Abbreviated Injury Scale (AIS). The results showed increasing head impacts with an increasing speed for all tram types and collision scenarios. Higher values of head acceleration were reached during the frontal impact (17-124 g) compared to the side one (2-84 g). The HIC15 values did not exceed the value of 300 for any experimental setting, and the probability of AIS4+ injuries did not exceed 10%. The outcomes of tram-pedestrian collisions can be influenced by the ATD's position and orientation, the impact speed and front-end design of trams, and the site of initial contact.

• MeSH
• chodci * MeSH
• chůze MeSH
• dopravní nehody MeSH
• kraniocerebrální traumata * MeSH
• lidé MeSH
• motorová vozidla MeSH
• rány a poranění * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Cíl: Metody časného odstranění trombu byly do praxe zavedeny s cílem zefektivnit léčbu hluboké žilní trombózy (HŽT). Práce hodnotí výsledky farmakomechanické trombektomie (FMT) u pacientů s akutní ileofemorální (IF) HŽT. Metodika: U 20 pacientů (8 mužů a 12 žen ve věkovém rozmezí 16-75 let) s akutní IF HŽT byla provedena FMT pomocí zařízení AngioJet, v 70 % v kombinaci s následnou katétrem řízenou lokální trombolýzou (KŘT). Průchodnost rekanalizovaného úseku byla kontrolována pomocí UZ před dimisí a následně za 3, 6, 12 měsíců a dále jednou ročně. Získaná data byla analyzována retrospektivně. Výsledky: Rekanalizace bylo dosaženo u všech pacientů, ve 20 % při primární FMT, v 80 % po následné KŘT a opakovaných intervencích, ve 40 % byl zaveden žilní stent. Medián celkového množství podaného trombolytika byl 34 mg. Medián délky endovaskulární léčby byl 21 hodin a celkové doby hospitalizace 6 dnů. Nezávažná klinicky relevantní krvácivá komplikace vznikla u tří pacientů (15 %). Během sledování s časovým odstupem 1 roku od zákroku byla zachována průchodnost rekanalizovaného žilního úseku ve 100 %. Závěr: V naší studii jsme prokázali vysokou efektivitu a bezpečnost léčby IF HŽT pomocí FMT. V časovém odstupu 1 rok od zákroku byla ve všech případech zachována průchodnost rekanalizovaného úseku

Purpose: Early thrombus removal techniques have been introduced to improve the effectiveness of deep vein thrombosis (DVT) treatment. This paper evaluates results of pharmacomechanical thrombectomy (PMT) in patients with acute iliofemoral (IF) DVT. Methods: 20 patients (8 males and 12 females, age range 16-75 years) with acute IF DVT underwent PMT using the Angiojet device, in 70% in combination with catheter-directed thrombolysis (CDT). The patency of the recanalized venous segment was verified ultrasonographically before discharge and subsequently at 3, 6, 12-month follow-up and annually thereafter. Obtained data were analyzed retrospectively. Results: Recanalization was achieved in all patients, in 20% at primary PMT, in 80% after subsequent CDT and repeated interventions. A venous stent was inserted in 40%. The median total amount of administered thrombolytic was 34 mg. The median duration of endovascular treatment was 21 hours, and the median total hospital stay was 6 days. A clinically relevant non-major bleeding complication occurred in 3 patients (15%). During follow-up 1 year after the procedure, 100% patency of the recanalized venous segment was maintained. Conclusion: In our study, we demonstrated high efficacy and safety of IF DVT treatment with PMT. The patency of the recanalized venous segment was preserved in all cases 1 year after the procedure.

• MeSH
• dospělí MeSH
• endovaskulární výkony metody   přístrojové vybavení   statistika a číselné údaje   MeSH
• fibrinolytika aplikace a dávkování   MeSH
• hluboká žilní trombóza horní končetiny * diagnostické zobrazování   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanická trombolýza * metody   přístrojové vybavení   statistika a číselné údaje   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH
• práce podpořená grantem MeSH

BACKGROUND: Endovascular aneurysm repair (EVAR) has created new possibilities for patients with abdominal aortic aneurysms (AAAs), and in recent years it has become tremendously popular. Use of EVAR in selected groups of patients allows mortality and morbidity to be reduced in comparison to open repair. However, complications such as endoleaks (ELs) can be of great concern and warrant urgent therapy to prevent sac rupture. CASE PRESENTATION: The case report presents urgent endovascular treatment of a high-risk type IA EL in a polymorbid 68-year-old patient 7 years after primary EVAR. The principle of treatment was parallel implantation of the proximal SG extension with the renal SG into the right renal artery (chimney technique). The subsequent type II collateral EL was treated by direct transabdominal AAA sac puncture and thrombin embolization. CONCLUSION: EL can be a cause for urgent intervention, but specific anatomic features often require specialized SG types which are not readily available. The chimney technique allows the use of immediately available stent grafts to address endoleak in the setting of impending abdominal aneurysm rupture.

• Publikační typ
• časopisecké články MeSH

The search for the "Holy Grail" in clinical diagnostic microbiology-a reliable, accurate, low-cost, real-time, easy-to-use method-has brought up several methods with the potential to meet these criteria. One is Raman spectroscopy, an optical, nondestructive method based on the inelastic scattering of monochromatic light. The current study focuses on the possible use of Raman spectroscopy for identifying microbes causing severe, often life-threatening bloodstream infections. We included 305 microbial strains of 28 species acting as causative agents of bloodstream infections. Raman spectroscopy identified the strains from grown colonies, with 2.8% and 7% incorrectly identified strains using the support vector machine algorithm based on centered and uncentred principal-component analyses, respectively. We combined Raman spectroscopy with optical tweezers to speed up the process and captured and analyzed microbes directly from spiked human serum. The pilot study suggests that it is possible to capture individual microbial cells from human serum and characterize them by Raman spectroscopy with notable differences among different species. IMPORTANCE Bloodstream infections are among the most common causes of hospitalizations and are often life-threatening. To establish an effective therapy for a patient, the timely identification of the causative agent and characterization of its antimicrobial susceptibility and resistance profiles are essential. Therefore, our multidisciplinary team of microbiologists and physicists presents a method that reliably, rapidly, and inexpensively identifies pathogens causing bloodstream infections-Raman spectroscopy. We believe that it might become a valuable diagnostic tool in the future. Combined with optical trapping, it offers a new approach where the microorganisms are individually trapped in a noncontact way by optical tweezers and investigated by Raman spectroscopy directly in a liquid sample. Together with the automatic processing of measured Raman spectra and comparison with a database of microorganisms, it makes the whole identification process almost real time.

• MeSH
• algoritmy MeSH
• lidé MeSH
• optická pinzeta MeSH
• pilotní projekty MeSH
• Ramanova spektroskopie * metody   MeSH
• sepse * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) is regularly used in treatment of clinically significant portal hypertension. Liver transplant recipients are, however, rarely indicated for the procedure. The study retrospectively examines the results of TIPS placement in 6 patients after OLT. METHODS: 4 males and 2 females (aged 36 to 62 years), treated with TIPS between 2007 a 2018, were included in the study. 5 patients had previously undergone liver transplantation for liver graft cirrhosis, 1 patient for Budd-Chiari syndrome. The piggyback caval reconstruction technique was selected in 4/6 cases. PH developed after OLT due to the recurrence of underlying liver condition and sinusoidal obstruction syndrome in half of the cases, respectively. Indications for TIPS were refractory ascites in 4 cases and variceal bleeding in 2 cases. RESULTS: Standard TIPS technique was used and technical success was achieved in all cases with a procedure-related complication in 1 patient. One patient died shortly after TIPS placement. The remaining patients all reported regression of clinically significant PH. Late complications appeared in 2 patients. Liver retransplantation after TIPS creation was performed in 1 case. Median TIPS patency was 55 months. 2/6 patient continue to thrive with a patent shunt. CONCLUSIONS: Transjugular intrahepatic portosystemic shunt in OLT recipients is technically feasible. Favorable clinical outcomes were reported particularly in patients treated for sinusoidal obstruction syndrome who were indicated to TIPS for refractory ascites.

• MeSH
• ascites etiologie   chirurgie   MeSH
• dospělí MeSH
• ezofageální a žaludeční varixy * etiologie   MeSH
• gastrointestinální krvácení etiologie   MeSH
• jaterní žilní okluze * etiologie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• transjugulární intrahepatální portosystémový zkrat * škodlivé účinky   metody   MeSH
• transplantace jater * škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

V článkuje prezentována úspěšná, urgentní endovaskulární léčba symptomatického endoleaku (EL) po 7 letech od primární implantace bifurkačního stentgraftu (SG) do aneurysmatu abdominálni aorty u staršího, polymorbidního muže se solitámí ledvinou. Kombinované paralelní zavedení renálního SG z brachiálního přístupu a proximální extenze distálně migrovaného SG zfemorálního přístupu vedlo k zániku EL typu IA při zachování perfuze solitámí rená lni tepny. Následně patrný ELtypu II byl v krátkém odstupu od výkonu úspěšně řešen přímou transabdominálni aplikací trombinu do vaku aneurysmatu. Při kontrole po 8 týdnech od aplikace trombinu byl pacient bez EL a s ním souvisejících klinických obtíží.

We present a successful urgent endovascular treatment of symptomatic endoleak (EL) 7 years after primary implantation of a bifurcation stent graft (SG) into abdominal aortic aneurysm in an elderly, polymorbid man with solitary kidney. Combined parallelinsertion of a renalSG from the brachialapproach and proximal extension of distally migrated SG from the femoral approach resulted in the resolution of type IA EL while preserving perfusion of the solitary renalartery. Subsequently, the apparent type II EL was successfully treated by direct, transabdominal injection of thrombin into the aneurysm sac. At follow-up 8 weeks after thrombin application, the patient was free of EL and associated clinical symptoms.

• MeSH
• cévní protézy MeSH
• endoleak * terapie   MeSH
• endovaskulární výkony MeSH
• lidé MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH