Evropská kardiologická společnost vydala v roce 2023 aktualizovaný doporučený postup pro diagnostiku a léčbu infekční endokarditidy (1), který byl následně přejat i Českou kardiologickou společností (2). Doporučení v oblasti antibiotické profylaxe a léčby bohužel obsahují mnohé nedostatky a chyby (3), proto tři české odborné společnosti vytvořily vlastní doporučení (4). Následující text je tedy kompilací těchto textů určený zejména pro internisty.
The European Society of Cardiology published an updated guideline for the diagnosis and treatment of infective endocarditis in 2023 (1), which was subsequently adopted by the Czech Society of Cardiology (2). Unfortunately, the recommendations in the areas of antibiotic prophylaxis and treatment contain many shortcomings and errors (3), which is why three Czech professional societies have developed their own recommendations (4). The following text is a compilation of these documents, primarily intended for internists.
- MeSH
- antibakteriální látky aplikace a dávkování terapeutické užití MeSH
- antibiotická profylaxe MeSH
- echokardiografie MeSH
- embolie prevence a kontrola MeSH
- endokarditida * diagnóza etiologie komplikace terapie MeSH
- kultivační vyšetření krve MeSH
- lidé MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
Prevalence arteriální hypertenze se sice celosvětově zvyšuje, roste ale i procento pacientů, kteří mají hypertenzi kontrolo- vanou. Při diagnostice a léčbě arteriální hypertenze se lékaři mohou opírat o doporučené postupy Evropské kardiologické společnosti (ESC) z roku 2024 a Evropské společnosti pro hypertenzi (ESH) z roku 2023. Obě sady doporučených postupů zdůrazňují stávající a přidávají nová doporučení. Hodnoty v rozmezí 120–139/70–89 mm Hg jsou dle ESC nově považovány za zvýšený krevní tlak. V diagnostice hypertenze je shoda na důrazu na měření krevního tlaku mimo zdravotnické zařízení. Zahájení farmakoterapie je indikováno u všech pacientů s hypertenzí společně s nefarmakologickými opatřeními. U většiny pacientů s hypertenzí, s výjimkou starých a křehkých, se farmakoterapie zahajuje fixní dvojkombinací v nižších dávkách, druhým krokem je trojkombinace nižších dávek. U pacientů se zvýšeným krevním tlakem a vysokým kardiovaskulárním rizikem je nově rovněž doporučována farmakoterapie. Cílové hodnoty systolického tlaku jsou v rozmezí 120–129 mm Hg, diastolického < 80 mm Hg. Obě sady doporučených postupů dále nabízejí odpověď na mnohé konkrétní situace spojené se specifickými skupinami pacientů, jako jsou pacienti mladší, pacienti starší, těhotné ženy, pacienti s renální insuficiencí apod.
Although the prevalence of arterial hypertension is increasing worldwide, the percentage of patients with controlled hypertension is also increasing. In diagnosing and treating arterial hypertension, doctors can rely on the European Society of Cardiology (ESC) 2024 and European Society of Hypertension (ESH) 2023 guidelines. Both sets of guidelines emphasize existing and add new recommendations. Values in the range of 120-139/70-89 mm Hg are now considered elevated blood pressure by ESC. In the diagnosis of hypertension, there is consensus on the emphasis on out-of-hospital blood pressure measurement. Initiation of pharmacotherapy is indicated in all patients with hypertension along with non-pharmacological measures. In most patients with hypertension, except for the old and frail, pharmacotherapy is initiated with a fixed two-combination at lower doses, the second step being a three-combination at lower doses. In patients with elevated blood pressure and high cardiovascular risk, pharmacotherapy is also newly recommended. Target values for systolic blood pressure are in the range 120-129 mm Hg, diastolic < 80 mm Hg. Furthermore, both sets of recommendations offer answers to many specific situations related to specific patient groups such as younger patients, older patients, pregnant women, patients with renal insufficiency, etc.
Hypertrofická kardiomyopatie (HKMP) je dědičné onemocnění srdce charakterizované zesílením svaloviny levé komory, které nelze vysvětlit hemodynamickým zatížením. Prevalence HKMP se odhaduje na 1 : 500, onemocnění má obecně dobrou prognózu, ale může vést k závažným komplikacím od dušnosti, arytmií, synkop přes srdeční selhání až k náhlé srdeční smrti. Dnešní pokrok v zobrazovacích metodách umožňuje identifikaci jednotlivých fenokopií HKMP ke správné- mu zacílení terapie. Toto sdělení se převážně zaměřuje na sarkomerickou HKMP, kde je nově průlomem v léčbě zařazení inhibitoru srdečního myozinu mavakamtenu do terapeutického algoritmu. Okrajově je prostor věnován diagnostice a te- rapii dalších fenokopií HKMP. Management těchto onemocnění vyžaduje multidisciplinární přístup ve specializovaných centrech k přesnému zacílení terapie.
Hypertrophic cardiomyopathy (HCMP) is an inherited heart disease characterized by thickening of the left ventricular musculature that cannot be explained by hemodynamic load. The prevalence of HCMP is estimated to be 1:500, the disease has a good prognosis in general, but can lead to serious complications from dyspnea, arrhythmias, syncope to heart failure and sudden cardiac death. Today's progress in imaging techniques allows the identification of individual phenocopies of HCMP to target therapy properly. This paper mainly focuses on sarcomeric HCMP, where a recent breakthrough in treatment is the inclusion of the cardiac myosin inhibitor mavacamten in the therapeutic algorithm. Marginal attention is given to the diagnosis and therapy of other phenocopies of HCMP. Management of these diseases requires a multidisciplinary approach in specialized centers to target therapy precisely.
- MeSH
- beta blokátory aplikace a dávkování terapeutické užití MeSH
- familiární hypertrofická kardiomyopatie genetika terapie MeSH
- hypertrofická kardiomyopatie * diagnóza etiologie komplikace terapie MeSH
- kardiochirurgické výkony MeSH
- lidé MeSH
- náhlá srdeční smrt prevence a kontrola MeSH
- obstrukce výtokového traktu levé komory srdeční chirurgie MeSH
- Check Tag
- lidé MeSH
Pancreatic cancers have high mortality and rising incidence rates which may be related to unhealthy western-type dietary and lifestyle patterns as well as increasing body weights and obesity rates. Recent data also suggest a role for the gut microbiome in the development of pancreatic cancer. Here, we review the experimental and observational evidence for the roles of the oral, gut and intratumoural microbiomes, impaired gut barrier function and exposure to inflammatory compounds as well as metabolic dysfunction as contributors to pancreatic disease with a focus on pancreatic ductal adenocarcinoma (PDAC) initiation and progression. We also highlight some emerging gut microbiome editing techniques currently being investigated in the context of pancreatic disease. Notably, while the gut microbiome is significantly altered in PDAC and its precursor diseases, its utility as a diagnostic and prognostic tool is hindered by a lack of reproducibility and the potential for reverse causality in case-control cohorts. Future research should emphasise longitudinal and mechanistic studies as well as integrating lifestyle exposure and multi-omics data to unravel complex host-microbiome interactions. This will allow for deeper aetiologic and mechanistic insights that can inform treatments and guide public health recommendations.
BACKGROUND: The innominate tributary of the small saphenous vein can be found medial to the calcaneal tendon, coursing proximally and draining into the trunk of the small saphenous vein in the distal third of the leg. The aim of our scientific paper is to thoroughly describe this innominate tributary, its incidence and relation to surrounding structures through anatomical dissection. METHODS: Authors thoroughly dissected sixty-one body donor lower limbs. As an adequate point of reference for measurements, the apex/tip of the lateral malleolus was selected. If a venous perforator was present, its position was related to the sole of the foot and to the posterior margin of the medial malleolus. In addition, each fibula was measured as a representation of the length of each limb. RESULTS: The investigated vein was found among 68.85 % (42/61) of lower limbs. Moreover, twenty-six bodies (83.87 %) evinced the vein in at least one of their legs. The average communication point with the trunk of the small saphenous vein lied 15.04 ± 3.94 cm (male limbs) and 15.05 ± 2.29 cm (female limbs) proximal to the lateral malleolus. On top of that, 82.93 % of veins also showed an interconnection with the posterior tibial perforators. CONCLUSION: This paper provides detailed anatomical data about the innominate tributary of the small saphenous vein. Our observation may propose new alternatives to traditional venous grafts from saphenous veins. Moreover, a significant relation to the perforators of the leg was found. Lastly, authors propose to denominate this vein as Achillean vein or calcaneal tendon vein.
- MeSH
- bérec krevní zásobení anatomie a histologie MeSH
- disekce MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vena brachiocephalica * anatomie a histologie MeSH
- vena saphena * anatomie a histologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The communicating veins between the great and small saphenous veins, called intersaphenous veins, are often overlooked structures, except for the femoral intersaphenous vein (of Giacomini). The reason for tendency to neglect the crural intersaphenous veins can be their alleged high variability. The aim of the study was to bring reliable anatomical and morphometric data about the crural intersaphenous veins for their potential clinical usage as grafts. MATERIAL AND METHODS: In this ultrasonographic study performed on a young population, we screened 246 lower extremities. The incidence of the femoral intersaphenous vein was 51.2 % (126/246) and the incidence of at least one crural intersaphenous vein was 97.1 % (239/246). Two crural intersaphenous veins were observed in 46.7 % (115/246). RESULTS: The femoral intersaphenous vein was located exclusively on the thigh, with its average length of 26.35 cm and average calibre of 2.4 mm. The typical area where to find a crural intersaphenous vein is the middle medial part of the calf. Their course can be straight transverse, oblique or they can rarely make a plexus. The majority of intersaphenous veins of the leg do not possess valves, if so, those are parietal valves present in 10.3 % (39/379). An average length of 13.7 cm and an average calibre of 2.13 mm of intersaphenous veins of the leg are appropriate enough for their usage as a venous graft or in reconstruction surgery. CONCLUSION: The intersaphenous veins of the leg are not as variable as presented in previous studies. Their anatomical and topographical characteristics are fairly constant. According to their anatomical characteristics, crural intersaphenous veins could be surgically used as a suitable variant to the great saphenous vein, small saphenous vein and femoral intersaphenous vein.
- MeSH
- bérec * krevní zásobení diagnostické zobrazování anatomie a histologie MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- ultrasonografie MeSH
- vena femoralis anatomie a histologie diagnostické zobrazování MeSH
- vena saphena * diagnostické zobrazování anatomie a histologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Neurons rely on the microtubule cytoskeleton to create and maintain their sophisticated cellular architectures. Advances in cryogenic electron microscopy, expansion microscopy, live imaging, and gene editing have enabled novel insights into mechanisms of centrosomal and acentrosomal microtubule nucleation, the key process generating new microtubules. This has paved the way for the functional dissection of distinct microtubule networks that regulate various processes during neuronal development, including neuronal delamination, polarization, migration, maturation, and synapse function. We review recent progress in understanding the molecular concepts of microtubule nucleation, how these concepts underlie neurodevelopmental processes, and pinpoint the open questions. Since microtubules play a pivotal role in axon regeneration within the adult central nervous system, understanding the processes of microtubule nucleation could inform strategies to enhance the regenerative capabilities of neurons in the future.
- MeSH
- centrozom * metabolismus fyziologie MeSH
- lidé MeSH
- mikrotubuly * metabolismus fyziologie MeSH
- neurogeneze * fyziologie MeSH
- neurony * fyziologie metabolismus MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF REVIEW: To review novel multiple sclerosis (MS) therapies currently in clinical trials. RECENT FINDINGS: Sixty-seven clinical trials were selected and grouped into the following categories: Bruton's tyrosine kinase inhibitors, remyelinating therapies, immunomodulators, B cell therapies, supplements/microbiome influencers, and cell-directed therapies. Important findings include tolebrutinib's successful trial in nonrelapsing secondary progressive MS that slowed CDP compared to placebo and simvastatin's failure to show an effect on disability in its phase 3 trial. SUMMARY: Multiple strategies are being investigated in MS to address progressive disability, myelin repair, neural protection and treatment refractory disease. Some of these strategies have successfully completed clinical trials giving hope that some of the most vexing aspects of MS will soon have new treatment options.
- MeSH
- imunologické faktory * terapeutické užití MeSH
- klinické zkoušky jako téma MeSH
- lidé MeSH
- roztroušená skleróza * terapie farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Cognitive impairment in Parkinson's disease (PD) is a key non-motor complication during the disease course. OBJECTIVES: A review of detailed cognitive instruments to detect mild cognitive impairment (PD-MCI) or dementia (PDD) is needed to establish optimal tests that facilitate diagnostic accuracy. METHODS: We performed a systematic literature review of tests that assess memory, language including premorbid intelligence, and visuospatial domains (for tests of attention and executive functions see accompanying review) to determine suitability to assess cognition in PD. Based on in-depth scrutiny of psychometric and other relevant clinimetric properties, tests were rated as "recommended," "recommended with caveats," "suggested," or "listed" by the International Parkinson and Movement Disorder Society (IPMDS) panel of experts according to the IPMDS Clinical Outcome Assessment Scientific Evaluation Committee guidelines. RESULTS: We included 39 tests encompassing 48 outcome measures. Seven tests (different versions or subtests of the test counted once) were recommended, including four for memory, one for visuospatial domains, one for language (including three measures), and one for estimated premorbid intelligence. Furthermore, 10 tests (12 measures) were "recommended with caveats," 11 were "suggested," and 11 (15 measures) were "listed." CONCLUSIONS: Recommended neuropsychological tests in memory, visuospatial functions, and language are proposed to guide the assessment of cognitive impairment and its progression in PD-MCI and PDD, and for use in clinical trials to stratify participants or as outcome measures. Novel measures being developed will need extensive validation research to be "recommended." © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
