Souhrn: Navzdory poklesu prevalence kompletní bezzubosti v posledních deseti letech zůstává bezzubost zejména v důsledku současného trendu stárnutí populace takřka celosvětovým palčivým problémem. Z terapeutických možností se kromě léty ověřené rehabilitace pomocí celkové snímatelné náhrady na základě průlomové publikace P. I. Brånemarka z roku 1977 spektrum terapie rozšiřuje i o implantologické řešení. Uplatnění implantátů je možné jak ke stabilizaci celkové snímatelné náhrady, tedy jako součást náhrady hybridní, tak i jako součást fixní protetické práce, která je nesena výhradně implantáty. Ideálním řešením u pacientů s rozsáhlejší atrofií alveolárního výběžku, kde je nutné esteticky korigovat i podporu rtů a tváří, případně kde by zuby ve fixních náhradách měly značně prodloužené klinické korunky, jsou náhrady hybridní. Hybridní náhrada přitom využívá širokou škálu komerčně dostupných retenčních prvků, které slouží pro retenci a stabilizaci protézy, přičemž se mohou jednotlivé fixtury spojovat nebo mohou stát samostatně. Jaké jsou možnosti při volbě jednotlivých retenčních prvků hybridních náhrad?
Summary: Despite the declining prevalence of complete toothlessness in the last ten years, mainly due to the current trend of population aging, the topic remains an almost global burning problem. Among the therapeutic options, in addition to conservative and by years proven rehabilitation with the help of a total removable prosthesis the spectrum of therapy has expanded on a basis of Brånemark's groundbreaking work published in 1977 to include implant supported solutions. The use of implants is possible both to stabilize the total removable prosthesis, as part of a hybrid prosthesis, and as part of a fixed prosthetic work, which is carried exclusively by dental implants. Hybrid prostheses are an ideal solution for patients with more extensive atrophy, where it is necessary to aesthetically correct the filling of the lips and face, or where teeth in fixed prostheses should have considerably elongated clinical crowns. The hybrid prostheses use a wide range of commercially available retention elements, which serve for fixation, retention and stabilization of the prosthesis, whereby the individual fixtures can be joined or they can stand separately. What exactly are our retention elements options for hybrid prostheses?
Background: In the last few decades, surgical techniques have been developed in thoracic surgery, and minimally invasive strategies such as multi-and uniportal video-assisted thoracic surgery (VATS) have become more favorable even for major pulmonary resections. With this surgical evolution, the aesthetic approach has also changed, and a paradigm shift has occurred. The traditional conception of general anesthesia, muscle relaxation, and intubation has been re-evaluated, and spontaneous breathing plays a central role in our practice by performing non-intubated thoracoscopic surgeries (NITS-VATS). Methods: We performed a computerized search of the medical literature (PubMed, Google Scholar, Scopus) to identify relevant articles in non-intubated thoracoscopic surgery using the following terms [(non-intubated) OR (non-intubated) OR (awake) OR (tubeless) OR (regional anesthesia)] AND [(VATS) OR (NIVATS)], as well as their Medical Subject Headings (MeSH) terms. Results: Based on the outcomes of the reviewed literature and our practice, it seems that pathophysiological concerns can be overcome by proper surgical and anesthetic management. All risks are compensated by the advantageous physiological changes that result in better patient outcomes. With the maintenance of spontaneous breathing, the incidence of potential adverse effects of mechanical ventilation, such as ventilator-induced lung injury and consequent postoperative pulmonary complications, can be reduced. The avoidance of muscle relaxants also results in the maintenance of contraction of the dependent hemidiaphragm and lower airway pressure levels, which may lead to better ventilation-perfusion matching. These techniques can be challenging for surgeons as well as for anesthetists; hence, a good knowledge of physiological and pathophysiological changes, clear inclusion and exclusion and intraoperative conversion criteria, and good communication between team members are essential. Conclusion: NITS-VATS seems to be a feasible and safe method in selected patients with evolving importance as a part of the minimally invasive surgical and anesthetic conception and has a role in reducing perioperative complications, which is crucial in the thoracic surgical patient population.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Candida parapsilosis is an emerging non-albicans Candida species that largely affects low-birth-weight infants and immunocompromised patients. Fungal pathogenesis is promoted by the dynamic expression of diverse virulence factors, with secreted proteolytic enzymes being linked to the establishment and progression of disease. Although secreted aspartyl proteases (Sap) are critical for Candida albicans pathogenicity, their role in C. parapsilosis is poorly elucidated. In the present study, we aimed to examine the contribution of C. parapsilosisSAPP genes SAPP1, SAPP2, and SAPP3 to the virulence of the species. Our results indicate that SAPP1 and SAPP2, but not SAPP3, influence adhesion, host cell damage, phagosome-lysosome maturation, phagocytosis, killing capacity, and cytokine secretion by human peripheral blood-derived macrophages. Purified Sapp1p and Sapp2p were also shown to efficiently cleave host complement component 3b (C3b) and C4b proteins and complement regulator factor H. Additionally, Sapp2p was able to cleave factor H-related protein 5 (FHR-5). Altogether, these data demonstrate the diverse, significant contributions that SAPP1 and SAPP2 make to the establishment and progression of disease by C. parapsilosis through enabling the attachment of the yeast cells to mammalian cells and modulating macrophage biology and disruption of the complement cascade.IMPORTANCE Aspartyl proteases are present in various organisms and, among virulent species, are considered major virulence factors. Host tissue and cell damage, hijacking of immune responses, and hiding from innate immune cells are the most common behaviors of fungal secreted proteases enabling pathogen survival and invasion. C. parapsilosis, an opportunistic human-pathogenic fungus mainly threatening low-birth weight neonates and children, possesses three SAPP protein-encoding genes that could contribute to the invasiveness of the species. Our results suggest that SAPP1 and SAPP2, but not SAPP3, influence host evasion by regulating cell damage, phagocytosis, phagosome-lysosome maturation, killing, and cytokine secretion. Furthermore, SAPP1 and SAPP2 also effectively contribute to complement evasion.
- MeSH
- aspartátové endopeptidasy genetika metabolismus MeSH
- buněčné linie MeSH
- Candida parapsilosis enzymologie patogenita MeSH
- faktory virulence genetika metabolismus MeSH
- fungální proteiny genetika metabolismus MeSH
- imunitní únik MeSH
- komplement imunologie MeSH
- lidé MeSH
- makrofágy mikrobiologie MeSH
- virulence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
AIM: Due to the emerging experience in VATS (video assisted thoracic surgery) lobectomies, in some centers the so called "non-intubated" VATS lobectomies (NITS - non-intubated thoracic surgery) gained increased authority, during which endotracheal intubation and muscle relaxation of the patient is not carried out, thus surgery is being performed with the patient breathing spontaneously. The recent study deals with our initial experience gained during uniportal NITS VATS lobectomies. PATIENTS AND METHOD: Between 24.01.2017 and 10.03.2017, 16 patients (female: 8; male: 8) with lung cancer underwent NITS VATS uniportal lobectomy. Mean age was 59.6 years (42-73 years). Mean FEV1 was 87.7% (62-109). Mean BMI was 27.1 (18.8-32.8). Prior to surgery, the patients received benzodiazepine premedication, local anesthetic (Lidocaine) for incision and Bupivacaine for intercostal and vagus nerve blockage. Besides routine monitoring Bispectoral Index (BIS) guided target-controlled infusion (TCI) Propofol sedation was carried out, with the help of laryngeal mask anesthesia. Skin and soft tissue incision was performed at the fifth intercostal space, in the axillary line. This single incision sight was the only one needed for the introduction of the camera, together with the instruments needed for dissection and resection of the lobe and placement of the chest tube. Complete atelectasis can develop. The following lobes were removed: 7 right upper lobes, 2 mid-lobes, 1 right lower lobe, 1 right lower lobe + right upper lobe wedge resection, 5 left lower lobes. After the resections, extended mediastinal sampling or block dissection was performed. RESULTS: There was no perioperative mortality. Conversion to endotracheal intubation was needed in non of the cases. Mean operative time was 96,5 minutes (80-120 min.), mean drainage periode was 2.9 days (2-8 days). Prolonged air leak was 1/16 (6.25%). Postoperative fever occurred in 1 patient and subcutaneous emphysema in 1 case, and 1 pneumonia. Because of a recurrent pneumothorax, a re-drainage was necessary in 1 case. Pathology of the resected lobes were as follows: 1 endobronchial hamartochondroma causing complete atelectasis of the lobe, 1 chronic pneumonia, and 10 adenocarcinomas, 2 squamous cell carcinomas, 1 carcinosarcoma, and 1 typical carcinoid. Staging of the 14 malignant cases were as follows: 8 IA, 2 IB, 1 IIA, 2 IIB, and 1 IIIA. The average number of the removed mediastinal lymph nodes is 12 (7-20). CONCLUSION: Non-intubated (NITS) VATS lobectomy is considered a safe procedure, satisfying all aspects of oncological guidelines. The postoperative drainage period was shorter caused by the complete atelectasis during the surgery.
- MeSH
- anestezie metody MeSH
- hrudní chirurgie video-asistovaná metody MeSH
- hypnotika a sedativa aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenektomie * MeSH
- nádory plic patologie chirurgie MeSH
- pneumektomie metody MeSH
- pooperační komplikace MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- implantace zubů * MeSH
- informovaný souhlas pacienta MeSH
- lidé MeSH
- právní odpovědnost * MeSH
- zákonodárství jako téma MeSH
- zubní implantáty * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- lidé MeSH
- zubní implantáty * dějiny MeSH
- Check Tag
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- lidé MeSH
- Publikační typ
- historické články MeSH
- Geografické názvy
- Česká republika MeSH
