Tento článek prezentuje nový doporučený klinický postup zaměřený na přístup k dětskému pacientovi s přítomností (či podezřením na přítomnost) cizího tělesa v gastrointestinálním traktu (GIT). Cílem práce bylo vytvořit algoritmus, který usnadní lékařům v prvním kontaktu s pacientem po požití cizího tělesa se rychle, přesně a efektivně rozhodnout o dalším diagnosticko-terapeutickém postupu. Pro usnadnění jsou cizí tělesa rozdělena do kategorií. Jednotlivé kategorie definují, jak moc bychom měli být ve svém přístupu aktivní. Zejména se jedná o identifikaci velmi rizikových situací nebo komplikací, a tedy rozhodnutí o neodkladném endoskopickém vyšetření, případně chirurgickém zákroku. Současně lze podle tohoto doporučení vyhodnotit, který pacient naopak nemusí být vůbec hospitalizován a může být sledován ambulantně. Algoritmus je navíc zpracován do grafického formátu, aby byl snadno a rychle dostupný v běžné praxi – na oddělení nebo v ambulancích, a pomohl tak k rychlému rozhodnutí a nalezení optimálního postupu pro konkrétního pacienta. Korespondující autor: MUDr. Michal Kubát Fakultní nemocnice v Motole V Úvalu 84/6 150 00 Praha 5 Michal.Kubat@fnmotol.cz
This article presents a novel recommended clinical approach focused on managing pediatric patients with the presence (or suspected presence) of a foreign body in the gastrointestinal tract (GIT). The objective of this work was to develop an algorithm that enables physicians at the initial point of contact with a patient who has ingested a foreign object to make rapid, accurate, and efficient decisions regarding the subsequent diagnostic and therapeutic steps. For the most effective approach, foreign bodies are categorized into different groups. These categories determine the level of clinical activity required, particularly in identifying high-risk situations or complications, thus guiding decisions on whether immediate endoscopic examination or surgical intervention is necessary. Simultaneously, this guideline allows for the assessment of patients who may not require hospitalization and can instead be monitored on an outpatient basis. Moreover, the algorithm is designed in a graphical format to be easily accessible in everyday practice – whether in hospital departments or outpatient clinics – thereby facilitating prompt decision-making and the identification of the optimal course of action for each specific patient.
- Publication type
- Meeting Abstract MeSH
- Publication type
- Meeting Abstract MeSH
Various strategies have been employed to improve the reliability of 2D, 3D, and co-culture in vitro models of nonalcoholic fatty liver disease, including using extracellular matrix proteins such as collagen I to promote cell adhesion. While studies have demonstrated the significant benefits of culturing cells on collagen I, its effects on the HepG2 cell line after exposure to palmitate (PA) have not been investigated. Therefore, this study aimed to assess the effects of PA-induced lipotoxicity in HepG2 cultured in the absence or presence of collagen I. HepG2 cultured in the absence or presence of collagen I was exposed to PA, followed by analyses that assessed cell proliferation, viability, adhesion, cell death, mitochondrial respiration, reactive oxygen species production, gene and protein expression, and triacylglycerol accumulation. Culturing HepG2 on collagen I was associated with increased cell proliferation, adhesion, and expression of integrin receptors, and improved cellular spreading compared to culturing them in the absence of collagen I. However, PA-induced lipotoxicity was greater in collagen I-cultured HepG2 than in those cultured in the absence of collagen I and was associated with increased α2β1 receptors. In summary, the present study demonstrated for the first time that collagen I-cultured HepG2 exhibited exacerbated cell death following exposure to PA through integrin-mediated death. The findings from this study may serve as a caution to those using 2D models or 3D scaffold-based models of HepG2 in the presence of collagen I.
- MeSH
- Cell Adhesion * drug effects MeSH
- Cell Death drug effects MeSH
- Hep G2 Cells MeSH
- Integrin alpha2beta1 metabolism MeSH
- Integrins metabolism genetics MeSH
- Collagen Type I * metabolism genetics MeSH
- Humans MeSH
- Non-alcoholic Fatty Liver Disease metabolism pathology MeSH
- Palmitates toxicity pharmacology MeSH
- Cell Proliferation * drug effects MeSH
- Reactive Oxygen Species metabolism MeSH
- Cell Survival * drug effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Pharmacokinetics MeSH
- Humans MeSH
- Liver Diseases drug therapy physiopathology MeSH
- Diarrhea etiology drug therapy MeSH
- Heartburn etiology drug therapy MeSH
- Gastrointestinal Microbiome MeSH
- Short Bowel Syndrome * drug therapy complications physiopathology MeSH
- Patient Care Team MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: Mucosal healing (MH) has become a perspective treatment target in patients with Crohn's disease (CD). Data about the impact of MH on long-term outcome in pediatric patients are still scarce. METHODS: Seventy-six pediatric patients with CD were evaluated retrospectively (2000-2015) in a tertiary care center. Based on MH achievement, they were divided into two groups (MH, N.=17; and No MH, N.=59). The primary endpoint was to assess the association of MH and the need for CD-related hospitalizations or surgery in pediatric patients with CD. RESULTS: The number of hospitalized patients was 24% in the MH group and 42% in the No MH group (P=0.26). The total number of CD-related hospitalizations was not significant between the MH group and the No MH group (5 vs. 41, P=0.15). The time to the first hospitalization was 24 months in MH and 21 months in No MH (P>0.99). About 24% of the patients in the MH group and 39% patients in the No MH group underwent CD-related operation (P=0.39). Time to the first operation was 43 months for MH and 19 months for the No MH group (P=0.13). The follow-up period was 91 months in the MH group and 80 months in the No MH group (P=0.74). The use of infliximab was positively associated with MH (P=0.002). CONCLUSIONS: MH was not associated with fewer CD-related hospitalizations or operations in pediatric patients with CD during seven years of follow-up.
- MeSH
- Time Factors MeSH
- Tertiary Care Centers MeSH
- Crohn Disease * therapy MeSH
- Child MeSH
- Wound Healing MeSH
- Hospitalization * statistics & numerical data MeSH
- Infliximab therapeutic use MeSH
- Humans MeSH
- Adolescent MeSH
- Follow-Up Studies MeSH
- Retrospective Studies MeSH
- Intestinal Mucosa * pathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Although some clinical studies have reported increased mitochondrial respiration in patients with fatty liver and early non‐alcoholic steatohepatitis (NASH), there is a lack of in vitro models of non‐alcoholic fatty liver disease (NAFLD) with similar findings. Despite being the most commonly used immortalized cell line for in vitro models of NAFLD, HepG2 cells exposed to free fatty acids (FFAs) exhibit a decreased mitochondrial respiration. On the other hand, the use of HepaRG cells to study mitochondrial respiratory changes following exposure to FFAs has not yet been fully explored. Therefore, the present study aimed to assess cellular energy metabolism, particularly mitochondrial respiration, and lipotoxicity in FFA‐treated HepaRG and HepG2 cells. HepaRG and HepG2 cells were exposed to FFAs, followed by comparative analyses that examained cellular metabolism, mitochondrial respiratory enzyme activities, mitochondrial morphology, lipotoxicity, the mRNA expression of selected genes and triacylglycerol (TAG) accumulation. FFAs stimulated mitochondrial respiration and glycolysis in HepaRG cells, but not in HepG2 cells. Stimulated complex I, II‐driven respiration and β‐oxidation were linked to increased complex I and II activities in FFA‐treated HepaRG cells, but not in FFA‐treated HepG2 cells. Exposure to FFAs disrupted mitochondrial morphology in both HepaRG and HepG2 cells. Lipotoxicity was induced to a greater extent in FFA‐treated HepaRG cells than in FFA‐treated HepG2 cells. TAG accumulation was less prominent in HepaRG cells than in HepG2 cells. On the whole, the present study demonstrates that stimulated mitochondrial respiration is associated with lipotoxicity in FFA‐treated HepaRG cells, but not in FFA‐treated HepG2 cells. These findings suggest that HepaRG cells are more suitable for assessing mitochondrial respiratory adaptations in the developed in vitro model of early‐stage NASH.
- MeSH
- Cell Line MeSH
- Hep G2 Cells MeSH
- Respiration MeSH
- Fatty Acids, Nonesterified MeSH
- Humans MeSH
- Mitochondria MeSH
- Non-alcoholic Fatty Liver Disease * MeSH
- Triglycerides MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Maintaining of remission early in the disease course of Crohn's disease (CD) is essential and has major impact on the future prognosis. This study aimed to identify baseline predictors to develop model allowing stratification of patients who will not benefit from long-term azathioprine (AZA) treatment and will require more intensive therapy. METHODS: This study was designed to develop clinical prediction rule using retrospective data analysis of pediatric CD patients included in prospective inception cohort. Clinical relapse was defined as necessity of re-induction of remission. Sequence of Cox models was fitted to predict risk of relapse. RESULTS: Out of 1190 CD patients from 13 European centers, 441 were included, 50.3% patients did not experience clinical relapse within 2 years of AZA treatment initiation. Median time to relapse was 2.11 (CI 1.59-2.46) years. Of all the tested parameters available at diagnosis, six were significant in multivariate analyses: C-reactive protein (p = 0.038), body mass index Z-score >0.8 SD (p = 0.002), abnormal sigmoid imaging (p = 0.039), abnormal esophageal endoscopy (p = 0.005), ileocolonic localization (p = 0.023), AZA dose in specific age category (p = 0.031). CONCLUSIONS: Although the possibility of predicting relapse on AZA treatment appears limited, we developed predictive model based on six baseline parameters potentially helpful in clinical decision. IMPACT: The possibility of predicting relapse on AZA treatment appears to be possible but limited. We identified six independent predictors available at diagnosis of early AZA/6-MP treatment failure in pediatric CD patients. Using combination of these factors, a model applicable to clinical practice was created. A web-based tool, allowing estimation of individual relapse risk in pediatric CD patients on a particular therapeutic regimen, has been developed.
- MeSH
- Azathioprine therapeutic use adverse effects MeSH
- Crohn Disease * complications diagnosis drug therapy MeSH
- Child MeSH
- Immunosuppressive Agents therapeutic use adverse effects MeSH
- Remission Induction MeSH
- Humans MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Akutní průjem je definován jako změna konzistence stolice na neformovanou (řídkou nebo tekutou) a/nebo zvýšení počtu defekací na více než tři během dne. Mezi další příznaky akutní gastroenteritidy (AGE) může patřit horečka, nevolnost a zvracení. Nejběžnější příčinou AGE jsou viry. V našich podmínkách jsou nejčastějším původcem rotaviry, které postihují v podzimním/zimním období kojence a batolata od 6 do 24 měsíců věku. Nejdůležitější součástí diagnostického a terapeutického postupu je posouzení míry dehydratace, které určuje závažnost AGE a je jedním z faktorů rozhodujících o hospitalizaci. Standardní léčbou první volby je perorální rehydratace hypoosmolárními tekutinami. Mezi další účinné postupy lze řadit podávání probiotik (Lactobacillus GG, Saccharomyces boulardii), racekadotrilu, diosmektitu a lze také zvážit použití ondansetronu snižujícího intenzitu nauzey a zvracení. Antibiotická terapie by měla být zvažována pouze ve výjimečných situacích. Chronický průjem může být způsoben celou řadou poruch, od nesnášenlivosti určité potraviny (nebo její složky, např. laktózy) až po příznak multisystémového onemocnění. Cílem sdělení je nabídnout ucelený přehled farmakoterapie průjmových onemocnění u dětí.
Acute diarrhoea is defined as a change in stool consistency from soft to liquid and/or an increase in the number of defecations to more than three per day. Other symptoms of acute gastroenteritis (AGE) include fever, nausea and vomiting. Viruses are the most common cause of AGE, with rotavirus being the most frequent causative agent, affecting mostly infants and toddlers aged 6-24 months during the autumn/winter period. The most important part of the diagnostic and therapeutic approach is the assessment of the degree of dehydration, which decides on the severity of AGE and serves as one of the factors determining hospitalization. The standard first-line treatment approach involves oral rehydration with hypoosmolar fluids. Other effective treatments include the administration of probiotics (Lactobacillus GG, Saccharomyces boulardii), racecadotril, diosmectin and perhaps ondansetron to reduce the intensity of nausea and vomiting. Antibiotic therapy should only be considered in specific clinical scenarios. Chronic diarrhoea may be caused by a range of disorders, from intolerance to a particular food (or food containing e.g. lactose) to a symptom of a multisystem disease. This overview aims to outline the current treatment options for diarrhoea in the paediatric population.
- MeSH
- Child MeSH
- Gastroenteritis * etiology drug therapy MeSH
- Infant MeSH
- Humans MeSH
- Probiotics therapeutic use MeSH
- Diarrhea * etiology drug therapy MeSH
- Fluid Therapy MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
