Multidisciplinary science
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PURPOSE OF REVIEW: To evaluate the role of extirpative surgery for the primary tumor in metastatic upper tract urothelial carcinoma (mUTUC). RECENT FINDINGS: The PubMed, Web of Science, and Cochrane Library were searched on July 2024 to identify relevant studies according to the Preferred Reporting Items for Systematic Review (PRISMA) statement. Studies were eligible for analysis if they compared oncologic outcomes between mUTUC patients who underwent surgical resection of the primary tumor and patients who did not. Cancer-specific survival (CSS) and overall survival (OS) were assessed using multivariate logistic regression analyses. We identified 2686 reports, of which 11 articles comprising 12 833 records were selected for this systematic review. Eight and three studies used Surveillance Epidemiology and End Results (SEER) and National Cancer Database (NCDB) databases, respectively. Surgical resection of the primary tumor was significantly associated with better CSS and OS in patients with mUTUC. Among the 5353 mUTUC patients included in our meta-analysis, radical nephroureterectomy (RNU) was independently associated with better OS with a pooled hazard ratio (HR) of 0.62 [95% confidence interval (CI) 0.54-0.72, P < 0.05]. Subgroup analyses of studies restricted to mUTUC patients with distant lymph node metastasis ( n = 1372) revealed RNU to be independently associated with better OS with pooled HR: 0.44 (95% CI 0.28-0.67, P < 0.05) together with systemic chemotherapy, primary tumor site in the ureter, lower T stage, and no locoregional lymph node involvement. SUMMARY: Surgical resection of the primary tumor offers oncologic survival benefits in select patients with mUTUC. However, in the absence of data from prospective randomized studies, it is essential to evaluate each patient individually as part of a collaborative multidisciplinary shared decision working with the patient.
- MeSH
- karcinom z přechodných buněk * chirurgie mortalita sekundární patologie MeSH
- lidé MeSH
- nádory ledvin * chirurgie mortalita patologie MeSH
- nádory močovodu * chirurgie mortalita patologie MeSH
- nefrektomie * metody MeSH
- nefroureterektomie * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
BACKGROUND: Identification of real-time adverse drug reactions [ADRs] (as opposed to the risk of ADRs) in older poly-medicated people in primary care is a challenging task, often undertaken without an explicit strategy. This systematic review aims to evaluate replicable instruments and methods for identifying and addressing ADRs. METHODS: A systematic search was conducted in Medline, CINAHL, Scopus, Web of Science and Cochrane library, using controlled vocabulary (MeSH) and free-text terms. Randomised controlled trials (RCTs) implementing strategies to identify or resolve ADRs experienced by patients in primary care were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Discrepancies were resolved by discussion. RESULTS: From 2,182 unique records, 49 studies were identified for full review. Eight papers reporting results from 6 RCTs were included. All six trials utilised a list of medicine-related unwanted symptoms to identify ADRs. Two of three studies using adverse drug reaction questionnaires reported statistically significant increased rates of ADR reporting. Two of three studies that combined symptom questionnaires with prescriber consultations reported reductions in the number of health problems. Overall, results suggest that the three studies that described multidisciplinary collaborations using lists of ADRs plus prescriber reviews enhanced patient safety. However, the RCTs were unblinded and reported suboptimal retention. When considered as a whole, findings are equivocal and the data are too heterogenous to warrant any firm conclusions, beyond the need for more research to optimise strategies to safeguard patient wellbeing. IMPLICATIONS: Adaptable and scalable instruments with decision support are needed in primary care to identify and mitigate medicine-related harm in older poly-medicated people. The effectiveness of adverse drug reaction identification instruments, the value of comprehensive instruments, and the optimum method of delivery should be explored in multicentre trials.
Negative pressure wound therapy (NPWT) is a very effective method in the treatment of dehiscent, infected, and non-healing wounds. Difficult wound healing occurs especially in late pregnancy due to the rapid enlargement of the uterus and the constantly increasing tension of the entire abdominal wall. In cases of dehiscence of the surgical wound during pregnancy, proper subsequent treatment is needed, where it is necessary to consider the safety of the mother as well as the fetus. We report the case of a 30-week pregnant patient who was surgically treated for acute appendicitis in pregnancy with an open appendectomy approach. Postoperative complications resulted in wound dehiscence with complete defect in fascia, which was treated with negative V.A.C. ATS® Therapy System. The therapy was started in the 30th week of pregnancy and continued until delivery with regular check-ups and regular redressing of the vacuum-assisted closure (VAC) system. At 38 weeks of pregnancy, the patient delivered vaginally with continued VAC therapy in situ. The final suture took place 3 days after vaginal delivery. Non-healing wounds with abdominal wall defects should be treated using a multidisciplinary approach, and NPWT can be used. This therapy can also be used during pregnancy. Vaginal delivery is preferred because it reduces the risk of further formation or deepening of the abdominal wall defect after a sufficient time interval from the start of the treatment. This complex case with a literature review of surgical complications in pregnancy treated with NPWT therapy highlights the advantage of a multidisciplinary approach.
- MeSH
- apendektomie * škodlivé účinky MeSH
- apendicitida chirurgie MeSH
- dehiscence operační rány * terapie etiologie MeSH
- dospělí MeSH
- komplikace těhotenství * chirurgie MeSH
- lidé MeSH
- těhotenství MeSH
- terapie ran pomocí řízeného podtlaku * metody MeSH
- vedení porodu metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
INTRODUCTION: Pediatric low-grade gliomas arising from the thalamus or thalamopeduncular junction are rare. Prognostic factors are thus seldom reported in the literature. RESEARCH QUESTION: This systematic review aims to define the factors influencing the prognosis of pediatric patients with thalamic and thalamopeduncular low-grade gliomas. MATERIAL AND METHODS: An extensive literature search in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed and included Web of Science, Scopus, and OVID interface (Medline and Embase). Original articles were selected if they provided data on 10 or more patients under 18 years old with separate or retrievable data for thalamic or thalamopeduncular low-grade gliomas, as well as at least one prognostic factor and its corresponding outcome. The risk of bias and applicability were assessed using The Quality Assessment of Prognostic Accuracy Studies criteria. RESULTS: The study selection process resulted in the inclusion of 14 articles out of the initial pool of 876 references. These 14 articles encompassed data from 446 patients. The prognostic factors reported were the extent of resection in ten studies, age and radiotherapy in four studies, bilateral involvement and molecular genetics in two studies, and sex and dissemination in one study each. Significant prognostic factors included the extent of resection, bilateral involvement, histology, and radiotherapy. DISCUSSION AND CONCLUSION: The reported factors considered significant for prognosis align with previously published data. The maximal safe resection, as a potentially curative modality for thalamic low-grade glioma, and the multidisciplinary approach to each patient should be a standard of care. Given the excellent long-term outlook of these patients, the extent of resection should not be pursued at the risk of neurological function since additional therapeutic possibilities are available today, such as molecular-targeted agents.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- časná detekce nádoru MeSH
- dávkové mechanismy MeSH
- dostupnost zdravotnických služeb organizace a řízení MeSH
- ekonomika a organizace zdravotní péče MeSH
- léčivé přípravky ekonomika zásobování a distribuce MeSH
- lékařská informatika MeSH
- lékové předpisy ekonomika MeSH
- lidé MeSH
- nádory prostaty diagnóza MeSH
- nemocnice všeobecné organizace a řízení MeSH
- osteoporóza diagnóza MeSH
- řízení veřejného zdraví * MeSH
- řízení zdravotnických informací MeSH
- služby péče o duševní zdraví organizace a řízení MeSH
- týmová péče o pacienty MeSH
- umělá inteligence MeSH
- zdravotnické informační systémy MeSH
- zdravotničtí záchranáři MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
Úvod a cíl: Sarkomy měkkých tkání představují neobvyklý typ malignity v oblasti hlavy a krku. Počet případů je popisován jako nízký. Mnoho autorů popisuje toto maligní onemocnění jako vzácný nádor hlavy a krku u dospělých. Na druhou stranu je sarkom součástí maligních onemocnění se špatnou prognózou v dětském, adolescentním a dospělém věku. Z literárních údajů vyplývá, že počty pacientů se sarkomy nelze přehlížet (27 908 případů za 7 let v Evropě na 500 mil. obyvatel). Sarkomy jsou sice málo častým zhoubným onemocněním, ale nejedná se o vzácné nádory. Proto potřebujeme aktuální poznatky a doporučení pro klinickou praxi v léčbě těchto heterogenních typů zhoubných mezenchymálních nádorů. Metoda: Analyzovali jsme literaturu o sarkomech hlavy a krku s využitím databáze Web of Science. Vyhledali jsme všechny práce popisující všechny typy léčby sarkomů v této oblasti. Tato studie analyzovala diagnostická kritéria sarkomů a léčebné plány sarkomů v oblasti hlavy a krku. Diskuze: Doporučení na základě mnoha faktorů. Sarkomy měkkých tkání v oblasti hlavy a krku jsou vzácné nebo málo časté. Incidence sarkomu měkkých tkání se pohybuje kolem 5 případů na 100 tis. obyvatel ročně. Musíme se zaměřit na nové znaky pro identifikaci rizikových faktorů sarkomu. Zásadní význam má proto patologické vyšetření a rozvoj molekulárních technik. Diagnostika na základě biopsie a histologie, včetně imunohistochemie a detekce specifických nádorových markerů. Doporučené zobrazovací metody: ultrazvuk, CT, HRCT, MR, PET CT. Přesná klasifikace a stratifikace musí být provedena v onkologickém týmu zahrnujícím patologa, onkologa, chirurga, radiologa. V literatuře byla uvedena obecná doporučení pro léčebný protokol a plánování léčby sarkomu hlavy a krku v závislosti na jeho velikosti, lokalizaci a biologickém chování. V literatuře byla popsána analýza údajů o základních léčebných modalitách v onkologické chirurgii, radioterapii a chemoterapii. V současné době nemáme k dispozici údaje o imunoterapii.
Objective: Soft tissue sarcomas represent a unique form of malignancy within the head and neck region, characterized by low incidence. Despite being commonly regarded as rare tumors in adults by numerous authors, sarcomas constitute a subset of malignant diseases associated with poor prognoses across diverse age groups, including children, adolescents, and adults. Recent literature highlights the considerable number of sarcoma cases reported, suggesting that while they may be uncommon, they are not truly rare, with 27,908 cases reported in a seven-year period in Europe among a population of 500 million inhabitants. This emphasizes the importance of recognizing sarcomas as infrequent tumors, rather than being rare. Consequently, it is essential to have up-to-date knowledge and evidence-based recommendations to inform and guide the clinical practice in the management of these heterogeneous types of mesenchymal tumors. Methods: We conducted a literature review about head and neck sarcomas using the Web of Science database. The objective of our review was to identify relevant papers discussing various treatment modalities of sarcomas in the head and neck region. This study analyzed the diagnostic criteria for sarcomas and the therapeutic approach, focusing on the surgical approach for the management of head and neck sarcomas. Discussion: Soft tissue sarcomas of the head and neck are infrequent, with an estimated annual incidence of approximately 5 per 100,000 individuals. Recommendations are based on numerous factors, while directing the attention towards identifying markers implicated as risk factors for sarcomas is crucial. Pathological review coupled with the advancement of molecular techniques is essential for this inquiry. Diagnosis relies heavily on biopsy and histological findings, including immunohistochemistry and the detection of specific tumor markers. Recommended imaging methods include ultrasound, CT, HRCT, MRI, and PET/CT scans. To achieve precise classification and stratification, we must include a multidisciplinary oncological team constructed of pathologists, oncologists, surgeons, and radiologists. Treatment protocol and planning for head and neck sarcomas take into consideration factors such as size, localization, and biological behavior, as described in existing literature. The literature extensively analyzes data connected to fundamental treatment modalities in oncology, including surgery, radiotherapy, and chemotherapy. Radical surgery, ensuring R0 margins, is definite in the treatment approach.
BACKGROUND: Among the non-traditional antibacterial agents in development, only a few targets critical Gram-negative bacteria such as carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii or cephalosporin-resistant Enterobacteriaceae. Endolysins and their genetically modified versions meet the World Health Organization criteria for innovation, have a novel mode of antibacterial action, no known bacterial cross-resistance, and are being intensively studied for application against Gram-negative pathogens. METHODS: The study presents a multidisciplinary approach, including genetic engineering of LysECD7-SMAP and production of recombinant endolysin, its analysis by crystal structure solution following molecular dynamics simulations and evaluation of antibacterial properties. Two types of antimicrobial dosage forms were formulated, resulting in lyophilized powder for injection and hydroxyethylcellulose gel for topical administration. Their efficacy was estimated in the treatment of sepsis, and pneumonia models in BALB/c mice, diabetes-associated wound infection in the leptin receptor-deficient db/db mice and infected burn wounds in rats. RESULTS: In this work, we investigate the application strategies of the engineered endolysin LysECD7-SMAP and its dosage forms evaluated in preclinical studies. The catalytic domain of the enzyme shares the conserved structure of endopeptidases containing a putative antimicrobial peptide at the C-terminus of polypeptide chain. The activity of endolysins has been demonstrated against a range of pathogens, such as Klebsiella pneumoniae, A. baumannii, P. aeruginosa, Staphylococcus haemolyticus, Achromobacter spp, Burkholderia cepacia complex and Haemophylus influenzae, including those with multidrug resistance. The efficacy of candidate dosage forms has been confirmed in in vivo studies. Some aspects of the interaction of LysECD7-SMAP with cell wall molecular targets are also discussed. CONCLUSIONS: Our studies demonstrate the potential of LysECD7-SMAP therapeutics for the systemic or topical treatment of infectious diseases caused by susceptible Gram-negative bacterial species and are critical to proceed LysECD7-SMAP-based antimicrobials trials to advanced stages.
- MeSH
- antibakteriální látky farmakologie aplikace a dávkování MeSH
- endopeptidasy * farmakologie aplikace a dávkování MeSH
- gramnegativní bakteriální infekce * farmakoterapie MeSH
- gramnegativní bakterie * účinky léků MeSH
- krysa rodu rattus MeSH
- myši inbrední BALB C * MeSH
- myši MeSH
- proteinové inženýrství metody MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- cirkulující nádorová DNA analýza krev MeSH
- interdisciplinární výzkum MeSH
- kolorektální nádory * diagnóza prevence a kontrola MeSH
- lidé MeSH
- nádorové biomarkery MeSH
- odběr vzorku krve MeSH
- plošný screening MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- komentáře MeSH
- souhrny MeSH
Tromboembolická nemoc, zahrnující hlubokou žilní trombózu a plicní embolii, je spojena s vysokou morbiditou a mortalitou. Chirurgické výkony představují významný rizikový faktor pro vznik tromboembolické nemoci. Prevence tromboembolické nemoci musí být přizpůsobena každému pacientovi individuálně na základě jeho rizikových faktorů a specifik každého chirurgického oboru s ohledem na typy prováděných výkonů. Indikace farmakologické prevence tromboembolické nemoci v urologii u seniorů patří k nejčastějším. S narůstající problematikou stárnutí populace se stává stále důležitější ve stáří přizpůsobovat lékové režimy individuálně, aby byla zachována bezpečnost farmakoterapie. Tento článek představuje systém prevence tromboembolické nemoci na Urologické klinice 1. lékařské fakulty UK a Ústřední vojenské nemocnice Praha. Strategie byla pro snadné každodenní používání v klinické praxi převedena do aplikačního software. Zavedení tohoto jednoduchého a přehledného nástroje vedlo k racionalizaci antikoagulační farmakoterapie. Jde o příklad mezioborové spolupráce mezi lékaři a klinickými farmaceuty, která je klíčová pro zlepšení péče o pacienty.
Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is associated with high morbidity and mortality rates. Surgical procedures are a significant risk factor for the development of venous thromboembolism. Preventing venous thromboembolism must be personalized for each patient, based on their individual risk factors and the specific nature of the surgical procedure, considering the types of surgeries performed. In urology, elderly patients are the most frequent recipients of pharmacological venous thromboembolism prevention. With the growing challenge of an aging population, it is increasingly important to customize drug regimens in older adults to ensure safe pharmacotherapy. This article outlines the venous thromboembolism prevention system at the Urology Clinic of the First Faculty of Medicine, Charles University, and the Military University Hospital Prague. The strategy has been integrated into application software for ease of use in daily practice. The implementation of this system has led to more rational anticoagulant pharmacotherapy. It serves as an example of interdisciplinary collaboration between physicians and clinical pharmacists, which is key to improving patient care.
- MeSH
- farmacie metody MeSH
- heparin nízkomolekulární aplikace a dávkování MeSH
- lékařská informatika metody MeSH
- lidé MeSH
- mezioborová komunikace MeSH
- perioperační péče metody MeSH
- pooperační komplikace prevence a kontrola MeSH
- rizikové faktory MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- software MeSH
- tromboembolie * prevence a kontrola MeSH
- urologické chirurgické výkony * škodlivé účinky MeSH
- urologie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
