OBJECTIVE: The study objectives were (i) to explore the agreement between the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and physical examination in assessing enthesitis in patients with spondyloarthritis (SpA) and (ii) to investigate the prevalence and clinical relevance of subclinical enthesitis in this population. METHODS: Twenty rheumatology centers participated in this cross-sectional study. Patients with SpA, including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), underwent both ultrasound scan and physical examination of large lower limb entheses. The OMERACT ultrasound lesions of enthesitis were considered, along with a recently proposed definition for "active enthesitis" by our group. Subclinical enthesitis was defined as the presence of "active enthesitis" in ≥1 enthesis in patients with SpA without clinical enthesitis (ie, number of positive entheses on physical examination and Leeds Enthesitis Index score = 0). RESULTS: A total of 4,130 entheses in 413 patients with SpA (224 with axSpA and 189 with PsA) were evaluated through ultrasound and physical examination. Agreement between ultrasound and physical examination ranged from moderate (ie, enthesophytes) to almost perfect (ie, power Doppler and "active enthesitis"). Patellar tendon entheses demonstrated the highest agreement, whereas Achilles tendon insertion showed the lowest. Among 158 (38.3%) of 413 patients with SpA with clinical enthesitis, 108 (68.4%) exhibited no "active enthesitis" on ultrasound. Conversely, of those 255 without clinical enthesitis, 39 (15.3%) showed subclinical enthesitis. Subclinical enthesitis was strongly associated with local structural damage. However, no differences were observed regarding the demographic and clinical profiles of patients with SpA with and without subclinical enthesitis. CONCLUSION: Our study underscores the need for a comprehensive tool integrating ultrasound and physical examination for assessing enthesitis in patients with SpA.

• MeSH
• Achilles Tendon diagnostic imaging   MeSH
• Axial Spondyloarthritis diagnostic imaging   MeSH
• Adult MeSH
• Enthesopathy * diagnostic imaging   MeSH
• Physical Examination * MeSH
• Middle Aged MeSH
• Humans MeSH
• Cross-Sectional Studies MeSH
• Arthritis, Psoriatic diagnostic imaging   complications   MeSH
• Spondylarthritis * diagnostic imaging   complications   MeSH
• Ultrasonography * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

OBJECTIVES: The aim of this study was to investigate the long-term effects of computer-assisted CiTM navigation on clinical, radiological, and functional results versus conventional total knee arthroplasty (TKA). PATIENTS AND METHODS: Between January 2005 and July 2011, a total of 85 patients (36 males, 49 females; mean age: 66.2±5.2 years; range, 59 to 84 years) who underwent P.F.C. SigmaTM knee system implantation using computer-assisted CiTM navigation system (BrainLAB®, DePuy International, Leeds, UK) and completed a minimum follow-up of eight years were included in the study. In the control group, a total of 100 patients (40 males, 60 females; mean age: 68.3±3.9 years; range, 60 to 79 years) who completed a minimum follow-up of eight years were randomly selected from a dataset of implanted P.F.C. SigmaTM knee systems in the same period using Specialist® 2 instrumentation without navigation. An implant survival analysis was used to compare implant survivorship between the groups throughout 12 years. The Knee Society Score (KSS) and range of motion (ROM) were assessed. Based on long-format X-ray images, the implant position in the frontal and sagittal planes was evaluated. RESULTS: The ratio for navigation to control group survival is approximately 1.01 at 12 years. The clinical outcomes showed no significant difference between the groups (knee scores, p=0.707 and functional scores, p=0.485). In the measured angles analysis, we observed a consistent pattern in both groups. In the control group, there was a trend toward implanting the tibial component with slight varus alignment (p=0.038) and a higher posterior slope (p<0.001). On average, the operation was prolonged by 13 min in the navigated group (p<0.001). CONCLUSION: In conclusion, our study results demonstrate that while kinematic navigation in TKA improves the precision of implant alignment, it does not provide significant benefits in terms of long-term implant survival or functional outcomes compared to conventional TKA methods. The use of the computer-assisted CiTM navigation system is associated with prolonged operation duration, although no technical complications related to the navigation device's software can be observed. Therefore, although navigation offers theoretical advantages in component positioning, its use may be more justifiable in cases with challenging alignment requirements rather than as a routine practice.

• MeSH
• Osteoarthritis, Knee * surgery   physiopathology   diagnostic imaging   MeSH
• Time Factors MeSH
• Surgery, Computer-Assisted * adverse effects   methods   instrumentation   MeSH
• Knee Joint * surgery   diagnostic imaging   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Recovery of Function MeSH
• Knee Prosthesis MeSH
• Retrospective Studies MeSH
• Range of Motion, Articular MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Arthroplasty, Replacement, Knee * methods   instrumentation   adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

Akné patří k nejčastějším kožním chorobám. Jedním z patogenetických faktorů u akné jsou změny v kožním mikrobiomu. V rozporu s předchozími domněnkami není akné spojena s nadbytečnou proliferací C. acnes, ale se ztrátou fylotypové diverzity C. acnes, především s predominancí C. acnes fylotypu IA1, a se ztrátou kožní mikrobiální diverzity. To vede k aktivaci vrozené imunity a následně k chronickému zánětlivému stavu. Cestou léčby je tedy potlačení patologických kmenů s ponecháním kmenů komensálních, tj. modifikace mikrobiomu. V článku je podrobně rozebrán mikrobiom u akné, vznik chronického zánětu a možnosti jeho nápravy.

Acne belongs to one of the most often skin diseases. One of its pathogenetic factors there are changes in a skin microbiom. In contrast with previous theories, acne is not caused with overproduction of C. acnes, but with a loss of phylotype diversity, first of all with a predominace of C. acnes phylotype IA, and with a loss of skin microbial diversity. It leeds to an activation of innate immunity and subsequently to a chronic inflammatory status. Therefore, the way of a treatment is a suppression of pathologic strains with a preservation of commensal ones, that means microbiom ́s modification. In an article, acne ́s microbiome, an origin of a chronic inflammation and possibilities of a treatment are described.

OBJECTIVE: ACHILLES aimed to demonstrate efficacy of secukinumab on Achilles' tendon enthesitis in spondyloarthritis (SpA) patients. METHODS: Patients ≥18 years (n = 204) with active PsA or axial SpA and heel enthesitis were randomized 1:1 to secukinumab 150/300 mg or placebo up to week 24, and thereafter placebo patients were switched to secukinumab. RESULTS: At week 24, a higher, yet statistically non-significant (P = 0.136), proportion of patients in secukinumab vs placebo reported resolution of Achilles tendon enthesitis in affected foot (42.2% vs 31.4%; odds ratio [OR] = 1.63; 95% CI: 0.87, 3.08). Proportion of patients reporting resolution of enthesitis based on Leeds Enthesitis Index was higher with secukinumab vs placebo (33.3% vs 23.5%; OR = 1.65; 95% CI: 0.85, 3.25) at week 24. Mean change from baseline in heel pain at week 24 was higher in secukinumab patients vs placebo (-2.8 [3.0] vs -1.9 [2.7]). Greater improvements with secukinumab were observed in heel enthesopathy activity and global assessment of disease activity. Imaging evaluation by local reading confirmed heel enthesitis on MRI at screening for all patients. Based on central reading, 56% presented with bone marrow oedema and/or tendinitis; according to Heel Enthesitis MRI Scoring System (HEMRIS) post hoc analysis, 76% had signs of entheseal inflammation while 86% had entheseal inflammation and/or structural changes. CONCLUSION: A substantial proportion of patients showed no signs of inflammation on the centrally read MRIs despite a clinical diagnosis of heel enthesitis, thus highlighting that the discrepancy between the clinical and imaging assessments of enthesitis requires further investigation. Although ACHILLES did not meet the primary end point, the study reported clinically meaningful improvements in patient-related outcomes. TRIAL REGISTRATION: clinicaltrials.gov, NCT02771210.

• MeSH
• Achilles Tendon MeSH
• Adult MeSH
• Enthesopathy * drug therapy   MeSH
• Antibodies, Monoclonal, Humanized * adverse effects   MeSH
• Humans MeSH
• Adolescent MeSH
• Spondylarthritis * drug therapy   MeSH
• Inflammation MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial, Phase III MeSH
• Randomized Controlled Trial MeSH

Pancreatic ductal adenocarcinoma (PDAC) is now the 11th most common cancer and in 2018 there were 458,918 new cases worldwide. In the Czech Republic, a total of 2,173 patients were diagnosed in 2015, ranking the second in incidence worldwide. In contrast to other malignancies, recent research has not brought any major breakthrough in the treatment of PDAC and hence the prognosis remains very serious. Radical resection is the only curative approach, but after the initiation of the standard pathological evaluation of the resected tissue, according to the Leeds protocol, 80% of the resections are R1 (resections with microscopically positive margins). The results of studies in patients with borderline resectable or locally advanced PDAC prefer neoadjuvant chemotherapy or chemoradiotherapy. This approach leads to a higher number of radical R0 resections and better survival. For neoadjuvant treatment in patients with primarily resectable PDAC, most results come from retrospective analysis or phase II trials. However, recently, data from three randomized clinical trials with neoadjuvant therapy for resectable PDAC were presented. These results support the use of chemotherapy or chemoradiotherapy prior to surgery. In the trials published to date, there are differences in chemotherapeutic regimens, cytostatic doses, and the definition of resectability. Thus, up-front resection with adjuvant chemotherapy is still the standard of care and a well-designed randomized trial using neoadjuvant therapy is now necessary.

• MeSH
• Carcinoma, Pancreatic Ductal * drug therapy   surgery   MeSH
• Humans MeSH
• Pancreatic Neoplasms * drug therapy   surgery   MeSH
• Neoadjuvant Therapy MeSH
• Antineoplastic Combined Chemotherapy Protocols therapeutic use   MeSH
• Randomized Controlled Trials as Topic MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Obtížná celospolečenská situace v souvislosti s covidem-19 představuje problém v oblasti nároků na psychickou integritu člověka. Onemocnění v rodině, ztráta zaměstnání a finanční nejistoty, stesky dětí a mladistvých po kamarádech a zájmových kroužcích, vlastní přepracovanost a omezené volnočasové aktivity a kontakty a další jiné mají za příčinu, že subjektivně zátěžové situace kladou mnohem vyšší nároky na naše každodenní zvládání dosud běžného života. Z toho vyplývá, že téměř rok trvající krize snížila adaptační kapacitu některých z nás a tím pádem více či méně aktuálně i běžné požadavky mohou ohrožovat u některých lidí jejich duševní zdraví.

Difficult world-wide covid 19 situation represents huge demands on how to stay in mental health. Illness impact on family, employment, financial, friendship, free time activites and many more- loss, being overworked and other subjective hard situations related to covid demand on our coping capacity and flexible strategies to have at least acceptable everyday living. Almoust a year duration of facing the crisis reduced our adaptive capacity and that is why even basic daily issues are hard to manage. International classification of mental ilnesses notice that if anybody is being under significant and chronic negative stress and that leeds him to unpleasant change, it takes all his individual stress resistence - it guides to maladaptation. This article provides basic psychological recommendations to prolonged stress with the aim to strenghten the reader in today and tomorrows struggle with being under stress. And to point out that this hard time must have word wide society mental image that shows exactly how we go through covid mentally.

• MeSH
• Adaptation, Psychological MeSH
• COVID-19 * MeSH
• Humans MeSH
• Stress, Psychological * prevention & control   MeSH
• Practice Guidelines as Topic MeSH
• Social Adjustment * MeSH
• Parent-Child Relations MeSH
• Professional-Patient Relations MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Epidemiologické studie terapie antioxidanty často nejsou úspěšné, ačkoliv oxidační stres byl hodnověrně prokázán. ROS látky mají svůj význam v signalizaci a zneškodňování bakterií, kvasinek, parazitů, virů leukocyty i nádorových buněk NK buňkami. Rovnováha mezi volnými radikály a antioxidanty je komplexní a pečlivě regulovaná. Její porušení vede k poškození homeostázy. Proto podání slabých prooxidantů je někdy pro prevenci nemocí užitečné (Halliwel, 2013). Oxidační stres znamená převahu ROS, resp. volných radikálů nad antioxidační obranou.

Epidemiological studies concerning on the therapy of antioxidants are not fully successful, despite the prove of oxidative stress. Reactive oxygen species (ROS) have a great importance in signalization and neutralisation of bacteries, yeasts, parasites, viruses with the help of leukocytes and tumor cells by NK cells. The balance between free radikals and antioxidants is complex and very carefully regulated. The disbalance of this system leeds to the disturbance of homeostasis. Therefore the application of weak prooxidants is sometimes useful for the prevention of deseases (Halliwel, 2013). Oxidative stress is characterised by the predominance of free radicals above the antioxidative defence.

• MeSH
• Antioxidants * MeSH
• Oxidation-Reduction MeSH
• Oxidative Stress * physiology   MeSH
• Lipid Peroxidation MeSH
• Reactive Oxygen Species MeSH
• Electron Transport Complex IV MeSH
• Free Radicals MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Reaching to target locations on the body has been studied little despite its importance for adaptive behaviors such as feeding, grooming, and indicating a source of discomfort. This behavior requires multisensory integration given that it involves coordination of touch, proprioception, and sometimes vision as well as action. Here we examined the origins of this skill by investigating how infants begin to localize targets on the body and the motor strategies by which they do so. Infants (7-21 months of age) were prompted to reach to a vibrating target placed at five arm/hand locations (elbow, crook of elbow, forearm, palm, and top of hand) one by one. To manually localize the target, infants needed to reach with one arm to the other. Results suggest that coordination increases with age in the strategies that infants used to localize body targets. Most infants showed bimanual coordination and usually moved the target arm toward the reaching arm to assist reaching. Furthermore, intersensory coordination increased with age. Simultaneous movements of the two arms increased with age, as did coordination between vision and reaching. The results provide new information about the development of multisensory integration during tactile localization and how such integration is linked to action.

• MeSH
• Touch physiology   MeSH
• Touch Perception physiology   MeSH
• Infant MeSH
• Humans MeSH
• Movement physiology   MeSH
• Proprioception physiology   MeSH
• Psychomotor Performance physiology   MeSH
• Child Development physiology   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Treatment of severely symptomatic patients with generalized anxiety disorder (GAD) raises particular concerns for clinicians. This 12-week double-blind study evaluated the efficacy of agomelatine (25-50 mg/day) in the treatment of patients with severe GAD, using escitalopram (10-20 mg) as active comparator. The primary outcome measure was the change from baseline of the total score on the Hamilton Anxiety scale (HAM-A) at week 12. Secondary outcome measures included rate of response to treatment (at least 50% score reduction from baseline) in the HAM-A psychic and somatic anxiety sub-scores, Clinical Global Impression severity and change scores, the Toronto Hospital Alertness Test, the Snaith-Hamilton Pleasure Scale, and the Leeds Sleep Evaluation Questionnaire Scores. Sixty one clinical centers (Australia, Canada, Czech Republic, Finland, Germany, Hungary, Poland, Russia, Slovakia) participated from April 2013 to February 2015. Patient characteristics and demographic data were comparable between treatment groups. Both treatments were associated with a clinically significant decrease in HAM-A total score at week 12; the non-inferiority of agomelatine versus escitalopram was not demonstrated (E(SE) = -0.91(0.69), 95%CI = [-2.26, 0.44], p = 0.195). At week 12, the response rate was 60.9% in the agomelatine group, and 64.8% in the escitalopram group. In both treatment arms, HAM-A psychic and somatic anxiety scores decreased, alertness and sleep parameters improved, and ability to experience pleasure increased. In these secondary outcome measures, there were no significant differences between the treatment groups. Agomelatine was well-tolerated, with a lower incidence of adverse events than escitalopram. Agomelatine and escitalopram are efficacious in treating GAD patients with severe symptoms.

• MeSH
• Acetamides adverse effects   therapeutic use   MeSH
• Anti-Anxiety Agents adverse effects   therapeutic use   MeSH
• Citalopram adverse effects   therapeutic use   MeSH
• Adult MeSH
• Interview, Psychological MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Psychiatric Status Rating Scales MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• Anxiety Disorders drug therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

INTRODUCTION: Tuberculosis (TB) remains a significant public health problem in South Asia. Tobacco use increases the risks of TB infection and TB progression. The TB& Tobacco placebo-controlled randomised trial aims to (1) assess the effectiveness of the tobacco cessation medication cytisine versus placebo when combined with behavioural support and (2) implement tobacco cessation medication and behavioural support as part of general TB care in Bangladesh and Pakistan. This paper summarises the process and context evaluation protocol embedded in the effectiveness-implementation hybrid design. METHODS AND ANALYSIS: We are conducting a mixed-methods process and context evaluation informed by an intervention logic model that draws on the UK Medical Research Council's Process Evaluation Guidance. Our approach includes quantitative and qualitative data collection on context, recruitment, reach, dose delivered, dose received and fidelity. Quantitative data include patient characteristics, reach of recruitment among eligible patients, routine trial data on dose delivered and dose received, and a COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') questionnaire filled in by participating health workers. Qualitative data include semistructured interviews with TB health workers and patients, and with policy-makers at district and central levels in each country. Interviews will be analysed using the framework approach. The behavioural intervention delivery is audio recorded and assessed using a predefined fidelity coding index based on behavioural change technique taxonomy. ETHICS AND DISSEMINATION: The study complies with the guidelines of the Declaration of Helsinki. Ethics approval for the study and process evaluation was granted by the University of Leeds (qualitative components), University of York (trial data and fidelity assessment), Bangladesh Medical Research Council and Bangladesh Drug Administration (trial data and qualitative components) and Pakistan Medical Research Council (trial data and qualitative components). Results of this research will be disseminated through reports to stakeholders and peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: ISRCTN43811467; Pre-results.

• MeSH
• Adult MeSH
• Smoking * adverse effects   MeSH
• Humans MeSH
• Randomized Controlled Trials as Topic MeSH
• Nicotiana MeSH
• Tuberculosis * epidemiology   MeSH
• Research Design MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Clinical Trial Protocol MeSH
• Geographicals
• Bangladesh MeSH
• Pakistan MeSH