OBJECTIVES: Acute hypoxemic respiratory failure in immunocompromised patients remains the leading cause of admission to the ICU, with high case fatality. The response to the initial oxygenation strategy may be predictive of outcome. This study aims to assess the response to the evolutionary profiles of oxygenation strategy and the association with survival. DESIGN: Post hoc analysis of EFRAIM study with a nonparametric longitudinal clustering technique (longitudinal K-mean). SETTING AND PATIENTS: Multinational, observational prospective cohort study performed in critically ill immunocompromised patients admitted for an acute respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1547 patients who did not require invasive mechanical ventilation (iMV) at ICU admission were included. Change in ventilatory support was assessed and three clusters of change in oxygenation modality over time were identified. Cluster A: 12.3% iMV requirement and high survival rate, n = 717 patients (46.3%); cluster B: 32.9% need for iMV, 97% ICU mortality, n = 499 patients (32.3%); and cluster C: 37.5% need for iMV, 0.3% ICU mortality, n = 331 patients (21.4%). These clusters demonstrated a high discrimination. After adjustment for confounders, clusters B and C were independently associated with need for iMV (odds ratio [OR], 9.87; 95% CI, 7.26-13.50 and OR, 19.8; 95% CI, 13.7-29.1). CONCLUSIONS: This study identified three distinct highly performing clusters of response to initial oxygenation strategy, which reliably predicted the need for iMV requirement and hospital mortality.
- MeSH
- Hypoxia * therapy mortality MeSH
- Immunocompromised Host * MeSH
- Intensive Care Units statistics & numerical data MeSH
- Critical Illness mortality therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Oxygen Inhalation Therapy * methods MeSH
- Prospective Studies MeSH
- Respiratory Insufficiency * therapy mortality MeSH
- Aged MeSH
- Cluster Analysis MeSH
- Respiration, Artificial * methods statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
Chronic myeloid leukemia (CML) treatment has been revolutionized over last 20 years because of tyrosine kinase inhibitors (TKIs) and patients with CML now have life expectancy of general population. Chronic TKI treatment may cause adverse effects (AEs) that vary in frequency and severity. Nilotinib shows common AEs with metabolic changes and skin AEs. Here, we present a case report of patient who experienced full psoriasis regression while treated with nilotinib. Dose reductions and an attempt to stop nilotinib treatment resulted in prompt psoriasis reappearance. This is the first documented case of positive effect of nilotinib on psoriasis.
- MeSH
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive * drug therapy complications MeSH
- Protein Kinase Inhibitors * therapeutic use adverse effects administration & dosage MeSH
- Humans MeSH
- Psoriasis * drug therapy complications chemically induced pathology MeSH
- Pyrimidines * therapeutic use adverse effects administration & dosage MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
BACKGROUND & AIMS: Exogenous recombinant fibroblast growth factor 20 (FGF20) protein has been proved to treat ulcerative colitis; however, its mechanism of action remains unclear. This study aimed to explore the role and mechanism of action of FGF20 in ulcerative colitis. METHODS: Data from patients with ulcerative colitis were analyzed using the Gene Expression Omnibus dataset. A murine colitis model was established by administering 2% dextran sodium sulfate. FGF20 knockout mice and Adenoassociated viruses (AAV)-FGF20-treated mice were used to elucidate the specific mechanisms. Proteomic analysis was conducted to identify differentially expressed genes. RESULTS: FGF20 levels were significantly elevated in the colonic tissues of subjects and mice with colitis. FGF20 deficiency exacerbated dextran sodium sulfate-induced colitis; in contrast, FGF20 replenishment alleviated colitis through 2 principal mechanisms: restoration of impaired intestinal epithelial barrier integrity, and inhibition of M1 macrophage polarization. Notably, S100A9 was identified as a pivotal downstream target of FGF20, which was further demonstrated by pharmacologic inhibition and overexpression experiments of S100A9 using paquinimod (a specific inhibitor of S100A9) and AAV-S100A9 in FGF20 knockout and AAV-FGF20 mice with colitis, respectively. Additionally, the nuclear factor-κB pathway was found to be involved in the process by which FGF20 regulates S100A9 to counteract colitis. CONCLUSIONS: These results suggest that FGF20 acts as a negative regulator of S100A9 and nuclear factor-κB, thereby inhibiting M1 macrophage polarization and restoring intestinal epithelial barrier integrity in mice with dextran sodium sulfate-induced colitis. FGF20 may serve as a potential therapeutic target for the treatment of ulcerative colitis.
- MeSH
- Fibroblast Growth Factors * metabolism genetics pharmacology MeSH
- Calgranulin B * metabolism genetics MeSH
- Colitis * chemically induced MeSH
- Humans MeSH
- Macrophages * immunology metabolism drug effects MeSH
- Disease Models, Animal MeSH
- Mice, Inbred C57BL MeSH
- Mice, Knockout MeSH
- Mice MeSH
- NF-kappa B * metabolism MeSH
- Signal Transduction MeSH
- Dextran Sulfate toxicity MeSH
- Intestinal Mucosa * pathology metabolism immunology drug effects MeSH
- Colitis, Ulcerative * pathology chemically induced immunology metabolism drug therapy MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Mice MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Učební texty Univerzity Karlovy
3. vydání 112 stran : ilustrace ; 21 cm
Vysokoškolská učebnice, která se zaměřuje na fyziologii gastrointestinálního systému člověka.; Učební text obsahuje přednášky z fyziologie trávicího traktu a je doplněn o patofyziologické nebo klinické poznámky související s popisovaným tématem.
- Conspectus
- Fyziologie člověka a srovnávací fyziologie
- Učební osnovy. Vyučovací předměty. Učebnice
- NML Fields
- fyziologie
- NML Publication type
- učebnice vysokých škol
- Keywords
- tandemová terapie CRRT a TPE,
- MeSH
- Renal Dialysis methods MeSH
- Child MeSH
- Liver Failure therapy MeSH
- Plasma Exchange methods MeSH
- Check Tag
- Child MeSH
- Publication type
- Case Reports MeSH
První vydání 53 stran : ilustrace ; 20 cm
Deník české autorky, ve kterém líčí své zkušenosti s paranoidní schizofrenií.
- MeSH
- History, 21st Century MeSH
- Persons with Psychiatric Disorders history psychology MeSH
- Homeopathy MeSH
- Schizophrenia, Paranoid history MeSH
- Women psychology MeSH
- Check Tag
- History, 21st Century MeSH
- Publication type
- Diary MeSH
- Geographicals
- Czech Republic MeSH
- Conspectus
- Psychiatrie
- Biografie
- NML Fields
- psychiatrie
BACKGROUND AND OBJECTIVE: Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UCOGC) is a rare variant of malignant pancreatic tumor. There is still no standardized treatment for this uncommon subtype, as surgical resection with lymphadenectomy is the only potentially curative treatment so far. In this paper, we describe the current knowledge of this very rare specific subtype of pancreatic cancer (PC) as a narrative review. METHODS: For this review, we did not specify the time range of studies referred to due to limited data availability. Our inclusion criteria comprised previous studies, which specifically focused on the rare UCOGC subtype of PC as a confirmed histopathology, either pure or present together with other subtypes. We disregarded the studies involving any other PC subtype but not UCOGC, including undifferentiated and anaplastic carcinomas without osteoclast-like giant cell components. KEY CONTENT AND FINDINGS: The limited available data precludes a definitive assessment of the efficacy of both neoadjuvant and adjuvant chemotherapy in the treatment of UCOGC. Monoclonal antibody pembrolizumab has been proven to be effective in metastatic cases. Multiple cases demonstrate a better overall survival rate for patients with UCOGC only versus those having UCOGC as a component with a pancreatic ductal adenocarcinoma (PDAC) histopathological subtype. The same conclusion can be also drawn comparing the survival rate of patients having pure UCOGC versus UCOGC with associated PDAC. Programmed cell death ligand-1 expression has been shown to be an important determinant, which shortens the survival period of patients diagnosed with UCOGC. CONCLUSIONS: The rarity of UCOGC limits data for clinical courses and treatment plans. We need more data to better understand the relationship between pathogenic mutations, histological subtypes, and prognosis in PC, including UCOGC. Understanding UCOGC's molecular, clinical, radiological, and pathological characteristics can lead to earlier, more accurate diagnoses and better management.
- Publication type
- Journal Article MeSH
- Review MeSH
AIM: Dental anxiety and well-being significantly influence patients' oral health and quality of life. This study investigated whether providing paper information leaflets (PILs) before performing dental procedures improved psychological well-being and reduced anxiety in Czech patients. MATERIALS AND METHODS: This parallel-group, single-blind randomized, prospective clinical trial was conducted at a private dental clinic in the Czech Republic in 2020. A total of 167 adult patients were randomly assigned to either the experimental group (n = 82), receiving both verbal information and a PIL, or the control group (n = 85), receiving only verbal information before their dental procedure (fillings, endodontic treatment, prosthetic restorations, or extractions). Pre- and post-procedure psychological well-being and anxiety were assessed using study-specific questionnaires. Data analysis was conducted in R using RStudio, with a significance level set at P < 0.05. Between-group differences were assessed while controlling for gender and education. Linear regression was used to analyze pre-procedure anxiety, and logistic regression was used to analyze post-procedure well-being outcomes (reporting "everything was fine," "unpleasant mouth sensations," and "quick adjustment"). The Benjamini-Hochberg correction was applied to control for multiple comparisons. Sensitivity analysis used the "best-worst and worst-best case" method to evaluate nonrandom missing data. Power analysis determined a minimum of 64 participants per group for a two-tailed t test. RESULTS: Baseline anxiety levels, measured on a 1-6 scale, were similar between the PIL group (mean 4.26, SD 1.11) and the control group (mean 4.36, SD 1.17; β = -0.11, P = 0.54). Post-procedure, while fewer patients in the PIL group reported that "everything was fine" (28/82 vs. 39/85), this difference was not statistically significant after correction for multiple comparisons (uncorrected P = 0.038, αFDR = 0.01). No significant differences were found between groups regarding "unpleasant mouth sensations" (P = 0.84) or "quick adjustment" (P = 0.52). CONCLUSION: Providing PILs in addition to verbal information did not significantly impact pre-procedure anxiety or post-procedure well-being in this sample of Czech dental patients. These findings indicate that verbal communication alone may be sufficient for managing patient anxiety and promoting well-being in this context. Further research using validated instruments and exploring different communication strategies is warranted.
- Publication type
- Journal Article MeSH
