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Aim of the study: To compare the intraocular pressure (IOP) lowering effect and postoperative complications between primary augmented trabeculectomy and glaucoma drainage device (GDD) implantation as primary surgical intervention in patients with juvenile-onset open angle glaucoma (JOAG). Patients and Methods: A retrospective review study involving 20 eyes that underwent primary augmented trabeculectomy with mitomycin (MMC) and 10 eyes GDD implantation in 3 tertiary centres in Malaysia between 1 January 2013 and 31 December 2019. They were followed up for at least 12 months postsurgical intervention. Intraocular pressure (IOP), number of topical IOP lowering medication and complications were evaluated at 1, 3, 6 and 12 months post-intervention. Based on the IOP, the success was divided into complete and partial success, and failure. IOP and postsurgical complications were compared using the Repetitive Measure Analysis of Variance (RM ANOVA) and the Pearson chi-square test. Results: Both methods were effective in lowering the IOP. Eyes with primary augmented trabeculectomy have significant lower IOP compared to GDD implantation (p = 0.037). There was a higher incidence of postoperative hypotony (30%) in the trabeculectomy group. There was also a significant reduction of mean number of topical pressure-lowering drugs required postoperatively (p = 0.015). Complete success was achieved in 100% of eyes with trabeculectomy and 67% in GDD implantation (p = 0.047). Conclusions: Primary augmented trabeculectomy and GDD implantation are good surgical options for the treatment of JOAG. Both methods provide IOP lowering at 1 year. However, trabeculectomy provides better pressure lowering, compared to GDD implantation in patients with JOAG.
Background: More than 50% of patients worldwide die in hospitals and end-of-life care is costly. We aimed to explore whether support from the palliative team can influence end-of-life costs. Methods: This was a descriptive retrospective case-control study conducted at a Czech tertiary hospital. We explored the difference in daily hospital costs between patients who died with and without the support of the hospital palliative care team from January 2019 to April 2020. Big data from registries of routine visits were used for case-control matching. As secondary outcomes, we compared the groups over the duration of the terminal hospitalization, intensive care unit (ICU) days, intravenous antibiotics, magnetic resonance imaging/computed tomography scans, oncological treatment in the last month of life, and documentation of the dying phase. Standard descriptive statistics were used to describe the data, and differences between the case and control groups were tested using Fisher's exact test for categorical variables and the Mann-Whitney U test for numerical data. Results: In total, 213 dyads were identified. The average daily costs were three times lower in the palliative group (4392.4 CZK per day = 171.3 EUR) than in the nonpalliative group (13992.8 CZK per day = 545.8 EUR), and the difference was probably associated with the shorter time spent in the ICU (16% vs. 33% of hospital days). Conclusions: We showed that the integration of the palliative care team in the dying phase can be cost saving. These data could support the implementation of hospital palliative care in developing countries.
- MeSH
- centra terciární péče MeSH
- hospitalizace MeSH
- lidé MeSH
- nemocnice univerzitní MeSH
- paliativní péče * MeSH
- péče o umírající * metody MeSH
- retrospektivní studie MeSH
- smrt MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND AND AIMS: Patients' perspectives after switching from originator to biosimilar adalimumab have yet to be assessed. We evaluated the efficacy of switching from the originator adalimumab to a biosimilar compound [SB5] in patients with inflammatory bowel disease [IBD]. METHODS: Data on IBD patients who were switched from the originator to biosimilar adalimumab [SB5] at IBD Center ISCARE were analysed. Disease activity was assessed using standard clinical indices (Harvey-Bradshaw index [HBI] for Crohn's disease [CD] and partial Mayo score for ulcerative colitis [UC]), and laboratory parameters (C-reactive protein [CRP] and faecal calprotectin [FC]). Trough levels and anti-drug antibodies were measured. Patients were evaluated 10 weeks [W10] after the switch, and results were compared with the control group of patients on originator compound. RESULTS: A total of 93 patients switched to biosimilar adalimumab were included [CD 86%] and were matched to 93 controls for age, gender, diagnosis, and disease activity. There was no difference in the disease activity in either SWITCH or ORIGINATOR cohorts between Weeks 0 and 10. Similarly, no difference was found between cohorts at both prespecified time points. Moreover, no significant differences in CRP or FC concentrations were seen between W0 and W10 either in the SWITCH, or in the ORIGINATOR cohort [p >0.05]. Adalimumab serum trough levels remained stable after the switch. No new safety signals were detected. CONCLUSIONS: Our study confirmed that switching IBD patients from the originator adalimumab to a biosimilar compound [SB5] does not affect treatment efficacy.
- MeSH
- adalimumab krev imunologie terapeutické užití MeSH
- biosimilární léčivé přípravky krev terapeutické užití MeSH
- C-reaktivní protein metabolismus MeSH
- centra terciární péče MeSH
- Crohnova nemoc krev farmakoterapie MeSH
- dospělí MeSH
- feces chemie MeSH
- gastrointestinální látky krev imunologie terapeutické užití MeSH
- leukocytární L1-antigenní komplex analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada léků MeSH
- protilátky krev MeSH
- retrospektivní studie MeSH
- stupeň závažnosti nemoci MeSH
- ulcerózní kolitida krev farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Eutrophication of surface water has been an important environmental issue for nearly half a century. High concentrations of phosphorus contribute to the process of eutrophication, resulting in the demand for effective and economic methods of phosphorus removal from treated water. The aim of this study was to evaluate the capacity for phosphorus removal of a microalgal biofilm during different light regimes. The photobioreactor was operated for nine months each year over a two-year period without interruption and without any need of re-inoculation. The algal biofilm was able to remove 97 ± 1% of total phosphorus from wastewater during 24 h of continuous artificial illumination. The average TP uptake rate in our experiments was 0.16 ± 0.008 g m(-2) d(-1). Phosphorus removal values ranged from 36 to 41% when the algal biofilm was illuminated by natural light (12 h sunlight-12 h night). The biomass production rate was 12.21 ± 10 g dry weight m(-2) d(-1) in experiments with continuous artificial light and 5.6 ± 1 g dry weight (DW) m(-2) d(-1) in experiments with natural light. These results indicate the great potential of microalgal biofilms in the tertiary treatment of wastewater.
- MeSH
- biodegradace MeSH
- biofilmy růst a vývoj MeSH
- biomasa MeSH
- chemické látky znečišťující vodu metabolismus MeSH
- čištění vody metody MeSH
- fosfor metabolismus MeSH
- fotobioreaktory * MeSH
- mikrořasy růst a vývoj metabolismus MeSH
- odpad tekutý - odstraňování metody MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Background: Scalp arteriovenous malformations (SAVM) are extremely uncommon vascular malformations, with only ~200 cases published in the English language in the past years. The objective of the present study was to describe the experience of a single reference service in neurosurgery. Methods: This is a descriptive and retrospective study conducted at our institution, which included cases of SAVM treated between 2001 and 2022. All information were extracted from the medical records of our institution. Patient confidentiality was preserved. Furthermore, an illustrative case has been described in detail. Results: Seven patients were included. The male-to-female ratio was 2.5: 1 and the mean age was 23.3 (3–42) years. Most cases (56.4%) were spontaneous and the lesions were located in the frontal (28.7%) and parietal (28.7%) regions. All lesions were supplied by more than one feeder, with the superficial temporal and occipital arteries being the most commonly involved (71.5%). Six patients underwent preoperative embolization, and 56.4% patients had scalp necrosis. Five patients underwent surgical resection, all without recurrence and with good postoperative evolution. Conclusions: More than one artery was involved in all cases, and the properties of the involved vessel influences the approach strategy. Surgical treatment is curative, and preoperative embolization helps reduce bleeding during the surgery. Complete resection of the lesions prevents associated complications, such as bleeding or recurrence. Scalp necrosis is a frequent complication in the treatment of these lesions, and a multidisciplinary approach involving reconstructive plastic surgery should always be considered.
PURPOSE OF THE STUDY To describe epidemiological and clinical features of pyogenic spinal infections in patients treated at the Department of Infectious, Parasitic and Tropical Diseases of the Hospital Na Bulovce in 2010-2014, and to analyse a predictive significance of selected variables. MATERIAL AND METHODS A single-centre retrospective cohort study carried out from 1.1.2010 to 31.12.2014 enrolled adult patients with septic spondylitis, discitis and facet joint infections. Recorded parameters included: demographics, chronic comorbidities, time to diagnosis, radiological work-up, anatomical level of spinal infection, source of infection, etiological agent, complications, treatment and outcomes. RESULTS Fifty-four patients were enrolled, 35 men (65%) and 19 women (35%), age range 33-90, mean age 63 years. Forty patients (74.1%) had a chronic comorbidity, 20 patients (37%) were obese. Time to diagnosis ranged between 1-90 days, mean 16.3 days. The diagnosis was assessed with MRI in 41 (75.9%) and CT in 11 patients (20.4%). Lumbosacral spine was affected in 38 (70.4%), thoracic in 14 (25.5%), cervical in 8 patients (14.8%), and 6 patients (11.1%) had a multilevel disease. Epidural abscess developed in 28 (51.9%), paravertebral oedema or abscess in 41 patients (75.9%). Endocarditis was diagnosed in 8 patients (14.8%). Aetiology was identified in 45 patients (83.3%), with Staphylococcus aureus isolated in 29 patients (53.7%). Twenty-two patients (40.7%) were treated surgically in addition to antibiotics. The mean length of hospital stay, parenteral antibiotic treatment and total antibiotic treatment was 48.7, 38.2 and 71.5 days, respectively. Thirty-six patients (66.6%) recovered with no or mild sequelae, 7 (13%) with severe sequelae, and 11 patients (20.4%) died. None of the analysed variables proved to be a statistically significant predictive factor of clinical outcome. DISCUSSION In accordance with previous studies pyogenic spinal infections were diagnosed mainly in elderly with chronic internal comorbidities, mostly with magnetic resonance imaging, they were often localized in lumbar spine, with staphylococci being the leading agents. In spite of unavailable CT-navigated biopsy, the aetiology was discovered in majority of patients. In contrast, this study found a more frequent posterior segments involvement, a shorter time to treatment, no tuberculous cases, a relatively high case fatality ratio, but less sequelae and no relapse. CONCLUSIONS The study confirmed an increasing incidence of pyogenic spinal infections, known predisposing factors, importance of MRI in diagnostics, disease predilection in lumbar spine, staphylococcal predominance in causative pathogens, and a relatively high case fatality ratio. Although time to treatment was not proved to be a negative predictive factor of clinical outcome, it is an imperative to strive for an early diagnosis and treatment. Predictors of clinical outcome have to be evaluated in a more extensive cohort of patients. Key words: spinal infection, discitis, spondylitis, spondylodiscitis, epidural abscess, psoas muscle abscess.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- čas zasáhnout při rozvinutí nemoci MeSH
- centra terciární péče MeSH
- discitida diagnostické zobrazování farmakoterapie mikrobiologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- meziobratlový kloub diagnostické zobrazování mikrobiologie MeSH
- ortopedické výkony MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spondylitida diagnostické zobrazování farmakoterapie mikrobiologie MeSH
- stafylokokové infekce diagnostické zobrazování farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: There is a paucity of published data on the clinical experience with trans-catheter aortic valve implantation (TAVI) in the Republic of Ireland. We sought to examine the clinical outcomes of patients with medium-term follow-up treated with TAVI at our institution. METHODS: A prospective TAVI registry was used to assess the baseline demographics, procedural variables and clinical outcomes of patients treated with TAVI between the inception of the programme in 2008 and November 2017. RESULTS: A total of 354 patients (mean age 80.9 ± 8.1 years, 58% male, mean STS score 6.1 ± 4.3%) were treated during the study period. Major in-hospital outcomes included in-lab death (n = 2, 0.6%), stroke (n = 8, 2.2%), device embolisation (n = 4, 1.2%), permanent pacemaker implantation (n = 22, 6.2%) and major vascular complication (n = 2, 0.6%). The median length of hospital stay was 4 days (IQR 2-8 days). The Kaplan-Meier estimate of freedom from death at 30 days and 1 year for the entire cohort was 97 ± 1% and 85.4 ± 2.3%, respectively. Trans-femoral access was associated with a significantly lower rate of death and/or stroke at 1 year compared to trans-apical access (84.9 ± 2.4% versus 60 ± 8.9%, p = 0.0005). There was no significant difference in freedom from death and/or stroke at 1 year between balloon-expandable and self-expanding valves (81.6 ± 2.6% versus 84.4 ± 7.4%, p = 0.63). CONCLUSION: This study documents low complication rates and favourable rates of survival following TAVI in a consecutive series of patients undergoing TAVI at a tertiary referral centre in the Republic of Ireland. These data support the application of this therapy in the Irish context.
- MeSH
- aortální chlopeň chirurgie MeSH
- aortální stenóza chirurgie MeSH
- centra terciární péče MeSH
- cévní mozková příhoda mortalita MeSH
- Kaplanův-Meierův odhad MeSH
- kohortové studie MeSH
- lidé MeSH
- prospektivní studie MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transkatetrální implantace aortální chlopně metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Irsko MeSH
PURPOSE: Patients with high-grade serous ovarian carcinoma (HGSOC) are virtually insensitive to immune checkpoint inhibitors (ICI) employed as standalone therapeutics, at least in part reflecting microenvironmental immunosuppression. Thus, conventional chemotherapeutics and targeted anticancer agents that not only mediate cytotoxic effects but also promote the recruitment of immune effector cells to the HGSOC microenvironment stand out as promising combinatorial partners for ICIs in this oncological indication. EXPERIMENTAL DESIGN: We harnessed a variety of transcriptomic, spatial, and functional assays to characterize the differential impact of neoadjuvant paclitaxel-carboplatin on the immunological configuration of paired primary and metastatic HGSOC biopsies as compared to neoadjuvant chemotherapy (NACT)-naïve HGSOC samples from five independent patient cohorts. RESULTS: We found NACT-driven endoplasmic reticulum stress and calreticulin exposure in metastatic HGSOC lesions culminates with the establishment of a dense immune infiltrate including follicular T cells (TFH cells), a prerequisite for mature tertiary lymphoid structure (TLS) formation. In this context, TLS maturation was associated with an increased intratumoral density of ICI-sensitive TCF1+PD1+ CD8+ T cells over their ICI-insensitive TIM-3+PD1+ counterparts. Consistent with this notion, chemotherapy coupled with a PD1-targeting ICI provided a significant survival benefit over either therapeutic approach in syngeneic models of HGSOC bearing high (but not low) tumor mutational burden. CONCLUSIONS: Altogether, our findings suggest that NACT promotes TLS formation and maturation in HGSOC lesions, de facto preserving an intratumoral ICI-sensitive T-cell phenotype. These observations emphasize the role of rational design, especially relative to the administration schedule, for clinical trials testing chemotherapy plus ICIs in patients with HGSOC. See related commentary by Bravo Melgar and Laoui, p. 10.
- MeSH
- CD8-pozitivní T-lymfocyty * imunologie účinky léků MeSH
- ektopické lymfoidní struktury * imunologie patologie MeSH
- hepatocytární jaderný faktor 1-alfa * genetika metabolismus MeSH
- inhibitory kontrolních bodů * terapeutické užití farmakologie MeSH
- karboplatina aplikace a dávkování farmakologie terapeutické užití MeSH
- lidé MeSH
- nádorové mikroprostředí * imunologie účinky léků MeSH
- nádory vaječníků * farmakoterapie imunologie patologie MeSH
- neoadjuvantní terapie metody MeSH
- paclitaxel aplikace a dávkování terapeutické užití farmakologie MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití farmakologie MeSH
- serózní cystadenokarcinom farmakoterapie patologie imunologie MeSH
- stres endoplazmatického retikula účinky léků imunologie MeSH
- tumor infiltrující lymfocyty imunologie účinky léků metabolismus MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
x, 158 s. : il., tab. ; 25 cm
- MeSH
- bronchogenní karcinom chirurgie MeSH
- bronchy chirurgie MeSH
- nádory plic chirurgie MeSH
- nádory průdušek diagnóza chirurgie MeSH
- následné studie MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- onkologie
- chirurgie
- pneumologie a ftizeologie
- NLK Publikační typ
- studie
Úvod: Přes pokroky v diagnostice a léčbě infekční endokarditidy (IE) přetrvává vysoká nemocnost i úmrtnost tohoto onemocnění. Cílem práce bylo posoudit vývoj spektra nemocných s IE hospitalizovaných v kardiocentru terciární nemocnice a identifikovat rizikové faktory mortality a recidivy IE. Soubor a metody: Retrospektivně byl analyzován soubor 334 nemocných s IE podle modifikovaných diagnostických kritérií (Duke), kteří byli hospitalizováni v Kardiocentru IKEM v Praze v letech 2000–2013. Uvedený časový interval jsme rozdělili do dvou sedmiletých období a porovnali charakteristiky nemocných s IE v obou obdobích. Pomocí Coxovy regresní analýzy jsme identifikovali prediktory mortality a recidivy IE během mediánu sledování 36 měsíců (4–77 měsíců). Výsledky: U 186 nemocných (56 %) se jednalo o IE na nativní chlopni, zatímco u 81 nemocných (24 %) o IE na chlopenní náhradě a u 67 nemocných (20 %) o IE v přítomnosti kardiostimulačního nebo defibrilačního systému. Při porovnání období let 2000–2006 a 2007–2013 jsme prokázali vzestup počtu pacientů hospitalizovaných pro IE o 78 %. Došlo k poklesu zastoupení nemocných s IE nativních chlopní a zvýšení podílu IE na chlopenních protézách a implantovaných přístrojích. I když vzrostl věk nemocných, zastoupení diabetu a jejich tělesná hmotnost (měřeno pomocí indexu tělesné hmotnosti), nedošlo ke zhoršení přežívání u jednotlivých typů IE. Recidivu IE během sledování jsme zjistili pouze u 3 % nemocných, častěji u intravenózních toxikomanů. Závěr: Ve sledovaném období jsme prokázali vzestup počtu pacientů hospitalizovaných pro IE. Zastoupení nemocných s IE nativních chlopní se snížilo, zatímco bylo zaznamenáno zvýšení podílu IE na chlopenních protézách a implantovaných přístrojích. I když se zhoršil rizikový profil nemocných, nebylo negativně ovlivněno přežívání u jednotlivých typů IE.
Introduction: Despite advances in diagnostics and treatment of infective endocarditis (IE), the high morbidity and mortality of this disease remains a substantial problem for health-care systems. Our aim was to describe the spectrum of IE in individuals hospitalised in a tertiary Czech hospital. In addition, we decided to identify risk factors for the mortality and recurrence of IE. Materials and methods: We performed a retrospective analysis in 334 patients diagnosed with definite IE according to modified Duke Criteria. The patients were hospitalised in the cardiac centre at IKEM during the years 2000–2013. This time period was divided into two seven-year intervals and patient characteristics were compared between these periods. Predictors of mortality and recurrence of IE were identified using Cox regression analysis within a median follow-up of 36 months (4–77 months). Results: The study group included 186 patients (56%) with native valve IE, 81 patients (24%) with prosthetic valve IE and 67 patients (20%) with device-related IE. Comparison of the time periods 2000–2006 and 2007–2013 revealed an increase in the number of patients with IE of 78%. Furthermore, the percentage of individuals with native valve IE decreased, which was accompanied by a marked increase in the proportion of prosthetic valve and device-related IE. Despite the increasing age of patients, the rising prevalence of diabetes and growing body weight (measured by body mass index), we observed a similar survival rate in both time periods for each type of IE. Recurrence of IE was observed in just 3% of patients during follow-up, but more frequently in intravenous drug addicts. Conclusion: Changing epidemiology of IE with increasing incidence of prosthetic valve and device-related IE was obvious also in our hospital. Although the risk profile of patients worsened, we observed a similar survival rate in both time periods for each type of IE.
