Tento článek prezentuje nový doporučený klinický postup zaměřený na přístup k dětskému pacientovi s přítomností (či podezřením na přítomnost) cizího tělesa v gastrointestinálním traktu (GIT). Cílem práce bylo vytvořit algoritmus, který usnadní lékařům v prvním kontaktu s pacientem po požití cizího tělesa se rychle, přesně a efektivně rozhodnout o dalším diagnosticko-terapeutickém postupu. Pro usnadnění jsou cizí tělesa rozdělena do kategorií. Jednotlivé kategorie definují, jak moc bychom měli být ve svém přístupu aktivní. Zejména se jedná o identifikaci velmi rizikových situací nebo komplikací, a tedy rozhodnutí o neodkladném endoskopickém vyšetření, případně chirurgickém zákroku. Současně lze podle tohoto doporučení vyhodnotit, který pacient naopak nemusí být vůbec hospitalizován a může být sledován ambulantně. Algoritmus je navíc zpracován do grafického formátu, aby byl snadno a rychle dostupný v běžné praxi – na oddělení nebo v ambulancích, a pomohl tak k rychlému rozhodnutí a nalezení optimálního postupu pro konkrétního pacienta. Korespondující autor: MUDr. Michal Kubát Fakultní nemocnice v Motole V Úvalu 84/6 150 00 Praha 5 Michal.Kubat@fnmotol.cz
This article presents a novel recommended clinical approach focused on managing pediatric patients with the presence (or suspected presence) of a foreign body in the gastrointestinal tract (GIT). The objective of this work was to develop an algorithm that enables physicians at the initial point of contact with a patient who has ingested a foreign object to make rapid, accurate, and efficient decisions regarding the subsequent diagnostic and therapeutic steps. For the most effective approach, foreign bodies are categorized into different groups. These categories determine the level of clinical activity required, particularly in identifying high-risk situations or complications, thus guiding decisions on whether immediate endoscopic examination or surgical intervention is necessary. Simultaneously, this guideline allows for the assessment of patients who may not require hospitalization and can instead be monitored on an outpatient basis. Moreover, the algorithm is designed in a graphical format to be easily accessible in everyday practice – whether in hospital departments or outpatient clinics – thereby facilitating prompt decision-making and the identification of the optimal course of action for each specific patient.
Králík patří mezi malé nepřežvýkavé býložravce. Anatomie a fyziologie trávicího traktu králíka se liší od velkých býložravců i přežvýkavců. Trávicí trakt je uzpůsoben k příjmu rostlinné potravy s vysokým obsahem vlákniny, která pro býložravce představuje hlavní zdroj energie. Na rozdíl od přežvýkavců probíhá trávení vlákniny u králíka především v tlustém střevě a je méně efektivní. V článku jsou shrnuty informace o anatomii a fyziologii trávicího traktu králíka a popsány zvláštnosti procesu trávení. Další specifika trávicího traktu jsou popsána také u králíčat na mléčné výživě.
The rabbit is a small non-chewing herbivore. The anatomy and physiology of the digestive tract of the rabbit differs from that of large herbivores and ruminants. The digestive tract is adapted to the intake of high-fibre plant foods, which are the main source of energy for herbivores. In contrast to ruminants, fibre digestion in the rabbit takes place primarily in the large intestine and is less efficient. This article summarises the anatomy and physiology of the rabbit digestive tract and describes the peculiarities of the digestive process. Further specifics of the digestive tract are also described for rabbits on milk diets.
DNA double-strand breaks (DSBs), such as those produced by radiation and radiomimetics, are amongst the most toxic forms of cellular damage, in part because they involve extensive oxidative modifications at the break termini. Prior to completion of DSB repair, the chemically modified termini must be removed. Various DNA processing enzymes have been implicated in the processing of these dirty ends, but molecular knowledge of this process is limited. Here, we demonstrate a role for the metallo-β-lactamase fold 5'-3' exonuclease SNM1A in this vital process. Cells disrupted for SNM1A manifest increased sensitivity to radiation and radiomimetic agents and show defects in DSB damage repair. SNM1A is recruited and is retained at the sites of DSB damage via the concerted action of its three highly conserved PBZ, PIP box and UBZ interaction domains, which mediate interactions with poly-ADP-ribose chains, PCNA and the ubiquitinated form of PCNA, respectively. SNM1A can resect DNA containing oxidative lesions induced by radiation damage at break termini. The combined results reveal a crucial role for SNM1A to digest chemically modified DNA during the repair of DSBs and imply that the catalytic domain of SNM1A is an attractive target for potentiation of radiotherapy.
- MeSH
- DNA metabolism genetics MeSH
- DNA Breaks, Double-Stranded * radiation effects MeSH
- DNA Repair Enzymes * metabolism genetics MeSH
- Exodeoxyribonucleases * metabolism genetics MeSH
- Humans MeSH
- DNA Repair * MeSH
- Proliferating Cell Nuclear Antigen metabolism genetics MeSH
- Cell Cycle Proteins MeSH
- Ubiquitination MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
The most commonly used flow cytometric (FCM) analysis of cellular DNA content relies on ethanol fixation followed by RNA digestion and propidium iodide (PI) intercalation into double-stranded DNA. This is a laborious and time-consuming procedure that is subject to systematic errors due to centrifugation and washing steps associated with sample preparation. It can adversely affect the reliability of the results. Here, we present a modified concept of DNA quantification in adherent cell lines by FCM that involves neither ethanol fixation nor any washing and cell transferring steps. Our high throughput assay of adherent cell lines reduces sample-processing time, requires minimal workload, provides a possibility for automation, and, if needed, also allows a significant reduction in the size of individual samples. Working with a well-proven commercial tool-The BD CycletestTM Plus DNA Reagent Kit-primarily designed for cell cycle analysis and aneuploidy determination in experimental and clinical samples, we suggest a novel, very efficient, and robust approach for DNA research in adherent cell cultures.
- MeSH
- Aneuploidy MeSH
- Automation MeSH
- Cell Adhesion MeSH
- Cell Cycle genetics MeSH
- DNA * analysis MeSH
- Humans MeSH
- Flow Cytometry * methods MeSH
- Reproducibility of Results MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.
- MeSH
- Child MeSH
- Electroencephalography methods MeSH
- Electrocorticography methods MeSH
- Epilepsies, Partial * diagnosis surgery MeSH
- Epilepsy * MeSH
- Humans MeSH
- Drug Resistant Epilepsy * diagnosis surgery MeSH
- Seizures diagnosis MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
Magnetic nanorobots offer wireless navigation capability in hard-to-reach areas of the human body for targeted therapy and diagnosis. Though in vivo imaging is required for guidance of the magnetic nanorobots toward the target areas, most of the imaging techniques are inadequate to reveal the potential locomotion routes. This work proposes the use of radiopaque magnetic nanorobots along with microcomputed tomography (microCT) for localized in vivo imaging applications. The nanorobots consist of a contrast agent, barium sulfate (BaSO4 ), magnetized by the decoration of magnetite (Fe3 O4 ) particles. The magnetic features lead to actuation under rotating magnetic fields and enable precise navigation in a microfluidic channel used to simulate confined spaces of the body. In this channel, the intrinsic radiopacity of the nanorobots also provides the possibility to reveal the internal structures by X-ray contrast. Furthermore, in vitro analysis indicates nontoxicity of the nanorobots. In vivo experiments demonstrate localization of the nanorobots in a specific part of the gastrointestinal (GI) tract upon the influence of the magnetic field, indicating the efficient control even in the presence of natural peristaltic movements. The nanorobots reported here highlight that smart nanorobotic contrast agents can improve the current imaging-based diagnosis techniques by providing untethered controllability in vivo.
- MeSH
- Gastrointestinal Tract * diagnostic imaging MeSH
- Contrast Media * chemistry MeSH
- Humans MeSH
- Magnetics MeSH
- X-Ray Microtomography MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Umělá inteligence (AI) se stále více zapojuje do medicíny včetně gastroenterologie, což otevírá nové možnosti pro diagnostiku a léčbu onemocnění trávicího traktu. ChatGPT, AI model založený na architektuře GPT-4, má potenciál zrychlit diagnostiku a léčbu, personalizovat léčbu, vzdělávat a školit zdravotníky, podporovat rozhodování a zlepšovat komunikaci s pacienty. Avšak s využitím AI přicházejí i výzvy, jako omezená schopnost AI nahradit lidský úsudek, chyby v datech, otázky související s bezpečností a ochranou osobních údajů a náklady na implementaci. Budoucnost ChatGPT v gastroenterologii závisí na schopnosti zpracovávat a analyzovat velké množství dat pro identifikaci vzorů a tvorbu individuálních léčebných plánů. ChatGPT se díky pokroku v AI a strojovém učení stává přesnějším a efektivnějším, což umožní rychlejší diagnostiku a léčbu gastroenterologických onemocnění. V oblasti vzdělávání bude ChatGPT sloužit jako neocenitelný zdroj informací o nejnovějších výzkumných článcích a postupech. Přes výhody AI v gastroenterologii je důležité řešit otázky etiky, ochrany dat a spolupráce mezi AI a zdravotnickými odborníky. Zajištění správných protokolů a postupů umožní bezpečné a etické využití AI v medicíně. Ačkoli AI přináší významný potenciál pro zlepšení kvality péče, je třeba řešit výzvy spojené s ochranou dat, bezpečností a etikou.
Artificial intelligence (AI) is increasingly being incorporated into medicine, including gastroenterology, opening new possibilities for the diagnosis and treatment of digestive tract diseases. ChatGPT, an AI model based on the GPT-4 architecture, has the potential to accelerate diagnosis and treatment, personalize care, educate, and train healthcare professionals, support decision-making, and improve communication with patients. However, with the use of AI come challenges such as the limited ability of AI to replace human judgment, data errors, issues related to security and personal data protection, and implementation costs. The future of ChatGPT in gastroenterology depends on its ability to process and analyze large amounts of data to identify patterns and create individual treatment plans. Thanks to advancements in AI and machine learning, ChatGPT is becoming more accurate and efficient, enabling faster diagnosis and treatment of gastroenterological diseases. In the field of education, ChatGPT will serve as an invaluable source of information on the latest research articles and procedures. Despite the benefits of AI in gastroenterology, it is essential to address issues of ethics, data protection, and collaboration between AI and healthcare professionals. Ensuring proper protocols and procedures will enable the safe and ethical use of AI in medicine. Although AI offers significant potential for improving the quality of care, it is necessary to address challenges associated with data protection, security, and ethics.
- Keywords
- ChatGPT,
- MeSH
- Algorithms MeSH
- Data Analysis MeSH
- Gastroenterology * MeSH
- Humans MeSH
- Artificial Intelligence * MeSH
- Check Tag
- Humans MeSH
16S rRNA amplicon sequencing or, more recently, metatranscriptomic analysis are currently the only preferred methods for microbial profiling of samples containing a predominant ratio of human to bacterial DNA. However, due to the off-target amplification of human DNA, current protocols are inadequate for bioptic samples. Here we present an efficient, reliable, and affordable method for the bacteriome analysis of clinical samples human DNA content predominates. We determined the microbiota profile in a total of 40 human biopsies of the esophagus, stomach, and duodenum using 16S rRNA amplicon sequencing with the widely used 515F-806R (V4) primers targeting the V4 region, 68F-338R primers and a modified set of 68F-338R (V1-V2M) primers targeting the V1-V2 region. With the V4 primers, on average 70% of amplicon sequence variants (ASV) mapped to the human genome. On the other hand, this off-target amplification was absent when using the V1-V2M primers. Moreover, the V1-V2M primers provided significantly higher taxonomic richness and reproducibility of analysis compared to the V4 primers. We conclude that the V1-V2M 16S rRNA sequencing method is reliable, cost-effective, and applicable for low-bacterial abundant human samples in medical research.
- MeSH
- Biopsy MeSH
- Gastrointestinal Tract MeSH
- Genes, rRNA MeSH
- Humans MeSH
- Microbiota * genetics MeSH
- Reproducibility of Results MeSH
- RNA, Ribosomal, 16S genetics MeSH
- Sequence Analysis, DNA methods MeSH
- High-Throughput Nucleotide Sequencing methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
We previously showed that L. (Leishmania) amazonensis promastigotes and amastigotes of the PH8 strain generated larger lesions in mice than LV79, and that lesion-derived amastigotes from the two strains differ in their proteomes. We recently reported that PH8 promastigotes are more phagocytized by macrophages. Promastigotes' membrane-enriched proteomes showed several differences, and samples of each strain clustered based on proteomes. In this paper, we show phenotypic differences between PH8 and LV79 promastigotes that may explain the higher virulence of PH8. We compared in vitro macrophage infections by day 4 (early) and day 6 (late stationary phase) cultures, resistance to complement, and LPG characteristics. PH8 promastigotes showed a higher infectivity and were more resistant to murine complement. LPG was different between the strains, which may influence the interaction with macrophages and survival to complement. We compared the infection of the permissive vector Lutzomyia longipalpis. PH8 was more abundant in the vector's gut 72 h after feeding, which is a moment where blood digestion is finished and the parasites are exposed to the gut environment. Our results indicate that PH8 promastigotes are more infective, more resistant to complement, and infect the permissive vector more efficiently. These data suggest that PH8 is probably better adapted to the sand fly and more prone to survive in the vertebrate host.
- Publication type
- Journal Article MeSH
Astaxanthin (AXT) is one of the most important fat-soluble carotenoids that have abundant and diverse therapeutic applications namely in liver disease, cardiovascular disease, cancer treatment, protection of the nervous system, protection of the skin and eyes against UV radiation, and boosting the immune system. However, due to its intrinsic reactivity, it is chemically unstable, and therefore, the design and production processes for this compound need to be precisely formulated. Nanoencapsulation is widely applied to protect AXT against degradation during digestion and storage, thus improving its physicochemical properties and therapeutic effects. Nanocarriers are delivery systems with many advantages─ease of surface modification, biocompatibility, and targeted drug delivery and release. This review discusses the technological advancement in nanocarriers for the delivery of AXT through the brain, eyes, and skin, with emphasis on the benefits, limitations, and efficiency in practice.
- MeSH
- Drug Delivery Systems * MeSH
- Humans MeSH
- Nanostructures administration & dosage chemistry MeSH
- Nanotechnology methods MeSH
- Preventive Medicine * MeSH
- Xanthophylls administration & dosage chemistry MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
