Stratified and precision nutrition refers to disease management or prevention of disease onset, based on dietary interventions tailored to a person's characteristics, biology, gut microbiome, and environmental exposures. Such treatment models may lead to more effective management of inflammatory bowel disease (IBD) and reduce risk of disease development. This societal position paper aimed to report advances made in stratified and precision nutritional therapy in IBD. Following a structured literature search, limited to human studies, we identified four relevant themes: (a) nutritional epidemiology for risk prediction of IBD development, (b) food-based dietary interventions in IBD, (c) exclusive enteral nutrition (EEN) for Crohn's disease (CD) management, and (d) pre- and probiotics for IBD management. There is scarce literature upon which we can make recommendations for precision or stratified dietary therapy for IBD, both for risk of disease development and disease management. Certain single-nucleotide polymorphisms related to polyunsaturated fatty acid (PUFA) metabolism may modify the effect dietary PUFA have in increasing the risk of IBD development. Non-colonic CD, mild-to-moderate CD, and high microbiota richness may predict success of EEN and may be used both for prediction of treatment continuation, but also for early cessation in nonresponders. There is currently insufficient evidence to make recommendations for precision or stratified dietary therapy for patients with established IBD. Despite the great interest in stratified and precision nutrition, we currently lack data to support conclusive recommendations. Replication of early findings by independent research groups and within structured clinical interventions is required.
BACKGROUND: The primary objective of this study was to conduct a comprehensive questionnaire survey on the practices of research ethics committees reviewing academic research projects in Czechia. The study aims to provide an unbiased and objective assessment of the current practices of research ethics committees, namely to obtain the missing data on their functioning in the context of academic research, to identify difficulties and shortages that threaten the responsible functioning of research ethics committees in the country and to investigate the implementation of Additional Protocol on Biomedical Research CETS No. 195 in their practice. Such research has never been conducted in Czechia. METHODS: This was a mixed-methods study, in which the online survey with closed and open-ended questions was chosen to explore the situation regarding ethics assessment of research involving human participants. We developed a questionnaire containing 18 questions concerning several aspects of the functioning of research ethics committees. The questionnaire was in Czech language and was administered through the Qualtrics platform anonymously. The target group of 61 research ethics committees at research institutions was approached by emails and we received 43 completely filled questionnaires, i.e., response rate of 67%. RESULTS: We obtained valuable data on the functioning of research ethics committees in Czechia in three main domains: the mandate and composition of the committee; the scope of its agenda; the process of evaluation including the voting procedure. In addition, the final set of open-ended questions provided an in-depth look at the problems faced by research ethics committees in Czechia. From the results is evident that the responsible assessment of the ethics of research involving human subjects is still not satisfactorily addressed and established for routine practice in the country. CONCLUSIONS: The outcomes of our study revealed that the main problem of research ethics in Czechia is the lack of national legislation on research ethics governance. To address this problem, the country requires a legislative framework accompanied by supportive measures aimed at educating, guiding and advising research ethics committees, especially in the Czech academic environment. TRIAL REGISTRATION NUMBER: Not applicable.
- MeSH
- biomedicínský výzkum etika MeSH
- etické komise - výzkum * MeSH
- etické zhodnocení MeSH
- etika výzkumu * MeSH
- experimenty na lidech etika MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
PURPOSE: Liver transplantation (LTx) is performed in individuals with urea cycle disorders when medical management (MM) insufficiently prevents the occurrence of hyperammonemic events. However, there is a paucity of systematic analyses on the effects of LTx on health-related outcome parameters compared to individuals with comparable severity who are medically managed. METHODS: We investigated the effects of LTx and MM on validated health-related outcome parameters, including the metabolic disease course, linear growth, and neurocognitive outcomes. Individuals were stratified into "severe" and "attenuated" categories based on the genotype-specific and validated in vitro enzyme activity. RESULTS: LTx enabled metabolic stability by prevention of further hyperammonemic events after transplantation and was associated with a more favorable growth outcome compared with individuals remaining under MM. However, neurocognitive outcome in individuals with LTx did not differ from the medically managed counterparts as reflected by the frequency of motor abnormality and cognitive standard deviation score at last observation. CONCLUSION: Whereas LTx enabled metabolic stability without further need of protein restriction or nitrogen-scavenging therapy and was associated with a more favorable growth outcome, LTx-as currently performed-was not associated with improved neurocognitive outcomes compared with long-term MM in the investigated urea cycle disorders.
V článku autoři popisují způsob zavedení postmortem CT angiografie do praxe na Ústavu soudního lékařství Fakultní nemocnice Ostrava v případech bodnořezných poranění končetin. Detailně je popsána nezbytná příprava cévního řečiště před provedením samotné angiografie, způsob aplikace kontrastní látky do cévního řečiště i praktické tipy usnadňující následné provedení konvenční pitvy. Stručně je uveden rovněž souhrn publikovaných prací zabývající se problematikou postmortem CT angiografie, popisující nejen její nesporné výhody, ale také limity a úskalí, která s sebou tato metoda přináší. Adresa pro korespondenci: MUDr. Bc. Jana Mertová Ústav soudního lékařství FN Ostrava 17. listopadu 1790/5, 708 52 Ostrava-Poruba Tel.: +420 597 371 713 Fax: +420 597 371 706 E-mail: jana.mertova@fno.cz Delivered: June 24, 2024 Accepted: July 24, 2024
This article describes a method of introducing postmortem CT angiography into daily forensic medicine practice involving cases of limb stab wounds investigated at the Department of Forensic Medicine, University Hospital Ostrava. The essential preparation of the vessels as well as practical tips facilitating the subsequent performance of a classic autopsy are described in detail. Article also includes brief review of published papers dealing with PMCT angiography related issues, advantages which brings CT angiography into forensic routine work, but also its limits and pitfalls.
- MeSH
- agar MeSH
- biomedicínský výzkum metody MeSH
- CT angiografie metody přístrojové vybavení MeSH
- forenzní zobrazování metody přístrojové vybavení MeSH
- končetiny diagnostické zobrazování zranění MeSH
- kontrastní látky MeSH
- lidé MeSH
- penetrující rány * diagnostické zobrazování MeSH
- pitva MeSH
- posmrtné zobrazování * metody přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
PURPOSE: The Core Outcome Measures Index (COMI) is a short, multidimensional instrument translated into several languages that covers five domains recommended in the assessment of outcome in patients with low-back and neck pain. The purpose of this study was to cross-culturally adapt the COMI from English to Czech language and to test the face and construct validity and reproducibility of its results in patients with low-back and neck pain. METHODS: Participants (n = 125) were included from primary and secondary care. The participants reported moderate pain and disability levels. All participants filled in the COMI forms before and after surgery. Descriptive statistics, Wilcoxon paired test, Crombach's alpha, principal component analysis and information entropy calculation were used. RESULTS: The instrument was successfully forward and back-translated. It can be seen that the questionnaire applied as part of our intervention study produces answers with a sufficient degree of variability and with a satisfactory degree of representation of extreme values. It can be also seen that the questionnaire can diagnose an objectively occurring change associated with the surgeon within the intervention procedure. Our other findings support the idea of a possible reduction in the number of questions that measure the same latent variable. Our investigations also showed that it is possible to reduce the range of the point scale of the perception of pain to 5 degrees of intensity and thus unify the range with the other questions. CONCLUSION: The Czech COMI shows acceptable properties and is thus suitable to use as a short instrument for measuring important domains in patients with low-back and neck pain.
- MeSH
- bolest krku * diagnóza MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie * diagnóza MeSH
- měření bolesti metody MeSH
- posuzování pracovní neschopnosti MeSH
- průzkumy a dotazníky normy MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- srovnání kultur * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
AIMS: The aim of this study was to evaluate the association of serum neurofilament heavy chain (sNfH) and chitinase 3-like 1 (sCHI3L1) with treatment response and disease activity in multiple sclerosis (MS). METHODS: This single-center, prospective, observational cohort study was conducted at the MS Centre, University Hospital Ostrava, Czech Republic, from May 2020 to August 2023. sNfH and sCHI3L1 were determined using ELISA. A mixed-effects linear model with a log-transformed outcome variable was applied. RESULTS: We analyzed 459 samples from 57 people with MS. Patients were sampled an average of 8.05 times during 21.9 months of follow-up. Those experiencing a relapse at sampling had a sNfH concentration 50 % higher than those in remission (exp(β) 1.5, 95 % CI 1.15-1.96). A longer duration of treatment was associated with lower sNfH (exp(β) 0.95, 95 % CI 0.94-0.96). Patients switched from low- to high-efficacy disease-modifying therapies (DMTs) had higher sNfH than patients treated with low-efficacy DMTs only (exp(β) 1.95, 95 % CI 1.35-2.81). Higher sCHI3L1 was associated with older age (exp(β) 1.01, 95 % CI 1.00-1.02) and longer DMT use (exp(β) 1.01, 95 % CI 1.00-1.02). sCHI3L1 values were not associated with relapse at the time of sampling, renal function, sex, or type of DMT. CONCLUSION: In contrast to sCHI3L1, sNfH may be a potential biomarker for monitoring treatment response and confirming clinical relapse in MS. Further research is needed to determine the long-term dynamics of sNfH and develop related treatment strategies.
- MeSH
- biologické markery * krev MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče MeSH
- imunologické faktory aplikace a dávkování farmakologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- neurofilamentové proteiny * krev MeSH
- prospektivní studie MeSH
- protein CHI3L1 * krev MeSH
- roztroušená skleróza krev farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: Multicenter precision oncology real-world evidence requires a substantial long-term investment by hospitals to prepare their data and align on common Clinical Research processes and medical definitions. Our team has developed a self-assessment framework to support hospitals and hospital networks to measure their digital maturity and better plan and coordinate those investments. From that framework, we developed PRISM for Cancer Outcomes: PR: agmatic I: nstitutional S: urvey and benchM: arking. OBJECTIVES: The primary objective was to develop PRISM as a tool for self-assessment of digital maturity in oncology hospitals and research networks; a secondary objective was to create an initial benchmarking cohort of >25 hospitals using the tool as input for future development. METHODS: PRISM is a 25-question semiquantitative self-assessment survey developed iteratively from expert knowledge in oncology real-world study delivery. It covers four digital maturity dimensions: (1) Precision oncology, (2) Clinical digital data, (3) Routine outcomes, and (4) Information governance and delivery. These reflect the four main data types and critical enablers for precision oncology research from routine electronic health records. RESULTS: During piloting with 26 hospitals from 19 European countries, PRISM was found to be easy to use and its semiquantitative questions to be understood in a wide diversity of hospitals. Results within the initial benchmarking cohort aligned well with internal perspectives. We found statistically significant differences in digital maturity, with Precision oncology being the most mature dimension, and Information governance and delivery the least mature. CONCLUSION: PRISM is a light footprint benchmarking tool to support the planning of large-scale real-world research networks. It can be used to (i) help an individual hospital identify areas most in need of investment and improvement, (ii) help a network of hospitals identify sources of best practice and expertise, and (iii) help research networks plan research. With further testing, policymakers could use PRISM to better plan digital investments around the Cancer Mission and European Digital Health Space.
- MeSH
- benchmarking MeSH
- biomedicínský výzkum MeSH
- lékařská onkologie metody MeSH
- lidé MeSH
- nádory MeSH
- onkologická péče - zařízení * MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The complexity of omes - the key cellular ensembles (genome and epigenome, transcriptome, proteome, and metabolome) - is becoming increasingly understood in terms of big-data analysis, the omics. Amongst these, proteomics provides a global description of quantitative and qualitative alterations of protein expression (or protein abundance in body fluids) in response to physiologic or pathologic processes while metabolomics offers a functional portrait of the physiological state by quantifying metabolite abundances in biological samples. Here, we summarize how different techniques of proteomic and metabolic analysis can be used to define key biochemical characteristics of pheochromocytomas/paragangliomas (PPGL). The significance of omics in understanding features of PPGL biology that might translate to improved diagnosis and treatment will be highlighted.
OBJECTIVE: To evaluate the reliability, responsiveness, and validity of the Scale for the Assessment and Rating of Ataxia (SARA) in patients with lysosomal storage disorders (LSDs) who present with neurological symptoms, and quantify the threshold for a clinically meaningful change. METHODS: We analyzed data from three clinical trial cohorts (IB1001-201, IB1001-202, and IB1001-301) of patients with Niemann-Pick disease type C (NPC) and GM2 Gangliosidoses (Tay-Sachs and Sandhoff disease) comprising 122 patients and 703 visits. Reproducibility was described as re-test reliability between repeat baseline visits or baseline and post-treatment washout visits. Responsiveness was determined in relation to the Investigator's, Caregiver's, and Patient's Clinical Global Impression of Improvement (CGI-I). The CGI-I data was also used to quantify a threshold for a clinically meaningful improvement on the SARA scale. Using a qualitative methods approach, patient/caregiver interviews from the IB1001-301 trial were further used to assess a threshold of meaningful change as well as the breadth of neurological signs and symptoms captured and evaluated by the SARA scale. RESULTS: The Inter-Class Correlation (ICC) was 0.95 or greater for all three trials, indicating a high internal consistency/reliability. The mean change in SARA between repeat baseline and post-treatment washout visit assessments in all trials was -0.05, SD 1.98, i.e., minimal, indicating no significant differences, learning effects or other systematic biases. For the CGI-I responses and change in SARA scores, Area Under the Curve (AUC) values were 0.82, 0.71, and 0.77 for the Investigator's, Caregiver's, and Patient's CGI-I respectively, indicating strong agreement. Further qualitative analyses of the patient/caregiver interviews demonstrated a 1-point or greater change on SARA to be a clinically meaningful improvement which is directly relevant to the patient's everyday functioning and quality of life. Changes captured by the SARA were also paralleled by improvement in a broad range of neurological signs and symptoms and beyond cerebellar ataxia. CONCLUSION: Qualitative and quantitative data demonstrate the reliability and responsiveness of the SARA score as a valid measure of neurological signs and symptoms in LSDs with CNS involvement, such as NPC and GM2 Gangliosidoses. A 1-point change represents a clinically meaningful transition reflecting the gain or loss of complex function.
- MeSH
- ataxie * diagnóza patofyziologie etiologie MeSH
- dítě MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče normy MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lyzozomální nemoci z ukládání diagnóza MeSH
- mladiství MeSH
- mladý dospělý MeSH
- předškolní dítě MeSH
- reprodukovatelnost výsledků MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Ciele štúdie: Cieľom tejto štúdie je sledovať kraniálne parametre pacientov so sagitálnou kraniosynostózou. Zameriame sa predovšetkým na rozdiely medzi endoskopickou a otvorenou chirurgickou liečbou a ich vplyv na zmeny kraniálnych parametrov u pacientov s kraniosynostózou sagitálneho švu. Kraniosynostóza má rôzne dôsledky, vrátane zníženého sebavedomia a problémov zapadnúť do detského kolektívu v dôsledku kraniofaciálnej deformity. Preto je dôležité sledovanie estetických výsledkov liečby kraniosynostózy u detských pacientov. Pacienti a metódy: Vzorka pacientov zaradených do tejto štúdie sa skladá z pacientov sledovaných neurochirurgom na Klinike detskej neurochirurgie Národného ústavu detských chorôb v Bratislave. Na sledovanie kraniálnych rozmerov boli použité klasické antropometrické metódy a nástroje. Výsledky: V našej štúdii sme nezaznamenali žiadne rozdiely v estetických výsledkoch medzi otvorenou a endoskopickou chirurgickou liečbou. Chirurgická liečba však bez ohľadu na typ zvolenej liečby priniesla požadované estetické výsledky a tieto výsledky sa časom zlepšovali. Záver: Prínosom práce bude longitudinálne sledovanie rastu detskej lebky, zhodnotenie efektivity chirurgickej liečby u pacientov s poruchami rastu neurokránia a prevencia neskorých následkov porúch rastu.
Objective: The aim of this study is to monitor the cranial parameters of patients with sagittal craniosynostosis. We will mainly focus on the differences between endoscopic and open-surgical treatment and their influence on changes in cranial parameters in patients with craniosynostosis of the sagittal suture. Craniosynostosis has various consequences, including reduced self-confidence and problems fitting in among other children due to craniofacial deformity. Therefore, monitoring aesthetic results of craniosynostosis treatment in pediatric patients is important. Patients and Methods: The sample of patients included in this study comes from patients monitored by the neurosurgeon at the Department of Paediatric Neurosurgery of the National Institute of Child Diseases in Bratislava, Slovakia. Standardized anthropometric methods and tools to monitor cranial dimensions were used. Results: In our study, we noted no differences in aesthetic results between open and endoscopic surgical treatment. However, surgical treatment, regardless of the type of chosen treatment, produced the desired aesthetic results, and these results improved over time. Conclusion: The benefit of the work will be the longitudinal monitoring of the growth of children‘s cranium, and the evaluation of the effectiveness of surgical treatment in patients with neurocranial growth disorders and the prevention of late consequences of growth disorders.
- MeSH
- antropometrie * metody přístrojové vybavení MeSH
- endoskopie klasifikace metody MeSH
- hodnocení výsledků zdravotní péče klasifikace MeSH
- kojenec MeSH
- kraniosynostózy * chirurgie diagnóza klasifikace MeSH
- kraniotomie metody MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- předškolní dítě MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
