Tukové tkanivo je dynamický metabolický orgán, ktorý zabezpečuje metabolickú homeostázu organizmu. Sekrécia adipocytokínov závisí od distribúcie tukového tkaniva, ako aj bunkového zloženia samotného tukového tkaniva – dôležitý je podiel adipocytov, stromálnych buniek, ciev a buniek imunitného systému. Cieľom našich prác, ktoré dokumentuje tento článok, je zistiť vplyv vybraných adipocytokínov na metabolické a imunologické komplikácie po transplantácii obličky. V našich analýzach sme nepotvrdili vplyv chronickej imunosupresie na hladiny adiponektínu a leptínu. Zistili sme však, že vyššie hladiny leptínu predikovali vývoj potransplantačného diabetes mellitus a nízke hladiny adiponektínu boli spojené s obezitou. Taktiež sme potvrdili, že hyperleptinemia je spojená s rozvojom akútnej rejekcie štepu a tvorbou donor špecifických protilátok.
Adipose tissue is a dynamic metabolic organ that regulates the metabolic homeostasis of the body. The secretion of adipocytokines depends on the distribution of adipose tissue, as well as the cellular composition of the adipose tissue itself - the proportion of adipocytes, stromal cells, blood vessels and cells of the immune system is important. In our analyses, the effect of chronic immunosuppression on adiponectin and leptin levels has not been confirmed. However, we found that higher leptin levels predicted the development of post-transplant diabetes mellitus and low adiponectin levels were associated with obesity and insulin resistance. It was also confirmed that hyperleptinemia is associated with the development of acute graft rejection and the formation of donor specific antibodies.
- MeSH
- adiponektin škodlivé účinky MeSH
- leptin škodlivé účinky MeSH
- lidé MeSH
- rejekce štěpu etiologie MeSH
- rizikové faktory MeSH
- transplantace ledvin * MeSH
- tukové buňky * imunologie metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Transplantace inzulin produkující tkáně je dnes zavedenou léčebnou metodou u pacientů s diabetem. U pacientů s diabetem 1. typu se při selhání ledvin stala metodou volby kombinovaná transplantace ledviny a pankreatu nebo ledviny a Langerhansových ostrůvků, u pacientů se syndromem nepoznané hypoglykemie zase transplantace samotného pankreatu nebo Langerhansových ostrůvků. Současná transplantace ledviny a pankreatu má pro pacienta význam nejen ve zlepšení kvality života (eliminace hypoglykemií, ukončení aplikace inzulinu a monitorování glykemií, uvolnění diety), ale i jako ochrana transplantované ledviny před rekurencí diabetického onemocnění ledvin a ve zlepšení či alespoň stabilizaci ostatních pozdních komplikací diabetu (diabetická polyneuropatie, retinopatie). I když s rozmachem technologií ubylo pacientů, kteří jsou indikováni k izolované transplantaci pankreatu nebo Langerhansových ostrůvků, stále existuje skupina pacientů, která není schopna tyto technologie ovládat nebo je odmítá. Novou možností léčby je autotransplantace Langerhansových ostrůvků u pacientů po pankreatektomii. Důležitou úlohu v dostupnosti transplantační léčby hraje včasná indikace a vhodná dlouhodobá příprava.
Transplantation of insulin-producing tissues is now an established treatment method for patients with diabetes. In patients with Type 1 diabetes, simultaneous kidney and pancreas or kidney and islet of Langerhans transplantation has become the method of choice in case of kidney failure, and in patients with unrecognized hypoglycemia syndrome, transplantation of the pancreas or islets of Langerhans alone has become the method of choice. The simultaneous transplantation of a kidney and pancreas is important for the patient not only in improving the quality of life (elimination of hypoglycemia, insulin administration, blood sugar monitoring, less strict diet), but also protect the renal graft from recurrent diabetic kidney disease and in the improvement or at least stabilization of other late diabetic complications (diabetic polyneuropathy, retinopathy). Even though the development of technology has reduced the number of patients who are indicated for transplantation of the pancreas or the islets of Langerhans themselves, there is still a group of patients who are unable to master these technologies or refuse them. A new treatment option is auto transplantation of the islets of Langerhans in patients after pancreatectomy. Early indication of the patient for transplantation, and appropriate long-term preparation play an important role in the availability of transplant treatment.
Nová doporučení KDIGO pro léčbu chronického onemocnění ledvin se zabývají širokou škálou klíčových témat, včetně optimálního hodnocení a klasifikace chronického onemocnění ledvin (CKD), hodnocení rizika onemocnění ledvin, léčby komplikací a farmakoterapie. Důraz, který je kladen na multidisciplinární týmovou práci, zapojení pacientů a holistický přístup k péči založený na důkazech, by měl přispět k lepší koordinaci pacientů s CKD. Nefrologové by si měli více všímat dalších interních komorbidit a spolupracovat na jejich léčbě.
The new KDIGO recommendations for the management of chronic kidney disease address a wide range of key topics, including optimal assessment and classification of chronic kidney disease (CKD), risk assessment of kidney disease, management of complications, and pharmacotherapy. The emphasis placed on multidisciplinary teamwork, patient involvement, and a holistic, evidence-based approach to care should contribute to better coordination for patients with CKD. Nephrologists should be more aware of other internal comorbidities and collaborate on their treatment.
- Klíčová slova
- KDIGO,
- MeSH
- časná diagnóza MeSH
- chronická nemoc * prevence a kontrola MeSH
- činnosti denního života MeSH
- glifloziny terapeutické užití MeSH
- hodnoty glomerulární filtrace účinky léků MeSH
- komorbidita MeSH
- lidé MeSH
- management nemoci MeSH
- nemoci ledvin * diagnóza dietoterapie etiologie farmakoterapie MeSH
- progrese nemoci MeSH
- receptor pro glukagonu podobný peptid 1 antagonisté a inhibitory MeSH
- týmová péče o pacienty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
OBJECTIVES: Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus reimplantation on a multicentre level with the use of propensity-score matching. METHODS: This was a retrospective international multicentre study of patients undergoing remodelling or reimplantation between 2010 and 2021. Twenty-three preoperative covariates (including root dimensions and valve characteristics) were used for propensity-score matching. Perioperative outcomes were analysed along with longer-term freedom from AV reoperation/reintervention and other major valve-related events. RESULTS: Throughout the study period, 297 patients underwent remodelling and 281 had reimplantation. Using propensity-score matching, 112 pairs were selected and further compared. We did not find a statistically significant difference in perioperative outcomes between the matched groups. Patients after remodelling had significantly higher reintervention risk than after reimplantation over the median follow-up of 6 years (P = 0.016). The remodelling technique (P = 0.02), need for decalcification (P = 0.03) and degree of immediate postoperative AV regurgitation (P < 0.001) were defined as independent risk factors for later AV reintervention. After exclusion of patients with worse than mild AV regurgitation immediately after repair, both techniques functioned comparably (P = 0.089). CONCLUSIONS: AV reimplantation was associated with better valve function in longer-term postoperatively than remodelling. If optimal immediate repair outcome was achieved, both techniques provided comparable AV function.
- MeSH
- anuloplastika srdeční chlopně metody MeSH
- aortální chlopeň * chirurgie MeSH
- aortální insuficience * chirurgie MeSH
- chirurgická náhrada chlopně metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- reoperace statistika a číselné údaje MeSH
- replantace * metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- tendenční skóre * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
BACKGROUND: This 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors. METHODS: The cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14. RESULTS: A total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient's 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction. CONCLUSION: In conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.
- MeSH
- dítě MeSH
- dospělí MeSH
- extrakce zubů MeSH
- kohortové studie MeSH
- lidé MeSH
- maxila * chirurgie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- ortodontická extruze metody MeSH
- počítačová rentgenová tomografie MeSH
- počítačová tomografie s kuželovým svazkem * MeSH
- resorpce zubního kořene diagnostické zobrazování etiologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- špičák * diagnostické zobrazování MeSH
- věkové faktory MeSH
- zaklíněný zub * chirurgie diagnostické zobrazování MeSH
- zubní ankylóza * diagnostické zobrazování MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach. METHODS: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated. RESULTS: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively. CONCLUSION: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.
- MeSH
- bederní obratle * chirurgie anatomie a histologie MeSH
- bederní svaly * anatomie a histologie chirurgie MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- mrtvola * MeSH
- nervus femoralis anatomie a histologie chirurgie MeSH
- nervus obturatorius anatomie a histologie chirurgie MeSH
- plexus lumbosacralis * anatomie a histologie chirurgie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The use of ventricular assist devices (VADs) in children is increasing. However, absolute numbers in individual centres and countries remain small. Collaborative efforts such as the Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) are therefore essential for combining international experience with paediatric VADs. Our goal was to present the results from the fourth Paedi-EUROMACS report. METHODS: All paediatric (<19 years) patients from the EUROMACS database supported by a VAD were included. Patients were stratified into a congenital heart disease (CHD) group and a group with a non-congenital aetiology. End points included mortality, a transplant and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident and pump thrombosis. RESULTS: A total of 590 primary implants were included. The congenital group was significantly younger (2.5 vs 8.0 years, respectively, P < 0.001) and was more commonly supported by a pulsatile flow device (73.5% vs 59.9%, P < 0.001). Mortality was significantly higher in the congenital group (30.8% vs 20.4%, P = 0.009) than in the non-congenital group. However, in multivariable analyses, CHD was not significantly associated with mortality [hazard ratio (HR) 1.285; confidence interval (CI) 0.8111-2.036, P = 0.740]. Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with body surface area (HR 0.524, CI 0.333-0.823, P = 0.005), CHD (HR 1.641, CI 1.054-2.555, P = 0.028) and pulsatile flow support (HR 2.345, CI 1.406-3.910, P = 0.001) in multivariable analyses. CONCLUSIONS: This fourth Paedi-EUROMACS report highlights the increasing use of paediatric VADs. The patient populations with congenital and non-congenital aetiologies exhibit distinct characteristics and clinical outcomes.
- MeSH
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- podpůrné srdeční systémy * statistika a číselné údaje škodlivé účinky MeSH
- předškolní dítě MeSH
- registrace * statistika a číselné údaje MeSH
- srdeční selhání mortalita chirurgie MeSH
- vrozené srdeční vady chirurgie mortalita MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- novorozenec MeSH
- zarděnky vrozené * diagnostické zobrazování epidemiologie etiologie patologie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
