• MeSH
• diabetes mellitus diagnóza   krev   MeSH
• glukózový toleranční test normy   MeSH
• referenční hodnoty MeSH
• senzitivita a specificita MeSH

The gold standard for diagnosis of celiac disease is positive serology confirmed by histological evidence of small intestinal biopsy damage as determined by the modified Marsh classification. Intraepithelial lymphocyte count has a pivotal importance in this grading criteria and the normal cut-off density has paramount importance in distinguishing between celiac disease and normal or false+ conditions. However its determination is problematic, complicated and far from being standardized. The localization along the villi or along the small bowel, the section thickness, the mode of detection and analysis, geoepidemiological influences, age dependency, associated infections or diseases and the strictness of the inclusions/exclusion criteria of the normal control group, all affect IEL density and normal cut-off levels. It is hoped that after standardization, the cut-off levels of IELs will better reflect the in-vivo reality to distinguish celiac disease from normal and associated conditions that affect intestinal IEL count.

• MeSH
• celiakie diagnóza   MeSH
• dítě MeSH
• dospělí MeSH
• imunohistochemie metody   MeSH
• lidé MeSH
• lymfocyty imunologie   patologie   MeSH
• počet lymfocytů metody   přístrojové vybavení   MeSH
• prediktivní hodnota testů MeSH
• střevní sliznice * imunologie   patologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH

Galactomannan antigen (GM) testing has been used for decades to screen immunocompromised patients for invasive aspergillosis (IA). Recent publications suggested that using a higher cut-off value than 0.5 in bronchoalveolar lavage fluid (BALF) could be more discriminant for hematology patients. We retrospectively analyzed the values of GM in BALF over 7 years (from 2010 to 2016). Performance indicators of the GM in BALF, according to three different cut-off values (0.5, 0.8, 1.5), were calculated using Stata 14.1. IA classification for hematology patients was based on European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, as defined in 2008. A number of 716 GM were performed on BALF from 2010 to 2016 (597 patients) and 66 were positive (> 0.5). Among these 597 patients, 27 IA were diagnosed, 13 with a positive GM in BALF, 9 with a negative GM in BALF, and 5 unclassified IA (ICU patients). The analysis of performance indicators, based on our local data, did not demonstrate any significant difference using a higher cut-off value of GM in BALF. This result may be explained by the local recruitment of patients and by pre-analytic variations during BALF realization.

• MeSH
• Aspergillus MeSH
• aspergilóza diagnóza   metabolismus   mikrobiologie   MeSH
• biologické markery MeSH
• bronchoalveolární lavážní tekutina * MeSH
• imunokompromitovaný pacient MeSH
• lidé MeSH
• mannany metabolismus   MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Introduction: Mutations in the TP53 gene are indicative of worse outcome in bladder cancer and are usually assessed by immunohistochemistry. To define p53-overexpression, a threshold of >10% is most commonly used (cut-off1). Recently, a novel cut-off (aberrant = 0% or ≥50%) (cut-off2) showed better correlation to clinical outcome. In this study, we evaluate the association between p53-immunohistochemistry cut-offs, clinico-pathological variables and disease-specific survival (DSS). Methods: Seven-hundred-fifty chemotherapy-naïve patients who underwent radical cystectomy were included (92% muscle-invasive bladder cancer. In addition to cut-off1 and cut-off2, a third cut-off (cut-off3) was determined based on the highest Youden-index value. Cut-off values were associated with clinico-pathological variables and FGFR3 mutation status. The Kaplan-Meier method was used to estimate DSS. Results: Aberrant p53-expression was found in 489 (65%) (cut-off1) and 466 (62%) (cut-off2) tumors. Cut-off3 was determined at 25% and aberrant p53-expression in 410 cases (55%) (cutoff3). p53-expression levels were significantly associated with higher pT-stage (cut-off1/2/3: P = 0.047, P = 0.006 and P = 0.0002, respectively), higher grade (all, P < 0.0001), and FGFR3 wild-type (cut-off1: P = 0.02, cut-offs2&3: P = 0.001). Median follow-up was 5.3 years (interquartile range, 4.0-6.0 years). p53-expression was not associated with DSS for any of the three cut-offs (cut-off1/2/3: P-log-rank = 0.566, 0.77 and 0.50, respectively). If we only considered locally advanced bladder cancer, results on DSS remained non-significant. Conclusion: This multi-center, multi-laboratory study showed that, regardless of the cut-off used, p53-immunohistochemistry did not enable selection of patients with worse outcome. Our results suggest that p53-immunohistochemistry alone is not suitable to guide clinical decision making after radical cystectomy.

• MeSH
• cystektomie MeSH
• geny p53 MeSH
• imunohistochemie MeSH
• lidé MeSH
• nádorový supresorový protein p53 * genetika   MeSH
• nádory močového měchýře * diagnóza   chirurgie   genetika   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

The objective of this paper was an evaluation of change in prevalence of overweight and obesity in Czech children, and a comparison of cut-off points for body mass index references from the Czech Republic (CzR), International Obesity Task Force and WHO. The authors conducted a survey in 7-year-old children, and compared data from 1951, 1981, 1991, 2001 and 2008 (WHO cut-offs). 2008 data were evaluated according to different cut-offs. Results showed that since 1951 in boys, overweight prevalence increased from 13.0% in 1951 to 26.8% in 2001, in girls from 10.9% to 22.9%. Obesity increased in boys from 1.7% to 8.3%, in girls from 1.7% to 6.9%. From 2001 to 2008 obesity in boys increased; obesity in girls and overweight in both genders decreased. In 2008 cohort the following values were found: overweight and obesity: CzR criteria, percentage was lowest (14.8% boys and 11.1% girls); WHO criteria, highest prevalence (23.5% boys and 19.5% girls); obesity: lowest ratio International Obesity Task Force criteria (4.4% boys, 3.3% girls), highest ratio boys WHO criteria (10.0%), girls CzR criteria (5.0%). Overweight and obesity prevalence increased in 7-year-old Czech children since 1951; since 2001 prevalence is plateauing with exception of boys. Using different body mass index references resulted in marked differences in overweight and obesity prevalence.

• MeSH
• dítě MeSH
• hodnotící studie jako téma MeSH
• index tělesné hmotnosti MeSH
• lidé MeSH
• nadváha epidemiologie   MeSH
• obezita epidemiologie   MeSH
• prevalence MeSH
• referenční hodnoty MeSH
• referenční standardy MeSH
• Světová zdravotnická organizace organizace a řízení   MeSH
• zdravotnické přehledy normy   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: The aim of the study was to determine the optimum cut-off value of the quantitative immunochemical test (q-FIT) OC-Sensor for colorectal cancer and advanced adenomatous polyps in a particular population. METHODS: 815 patients were referred for colonoscopy and were offered two q-FIT examinations at two different colonoscopy centers. The patients were classified according to the colonoscopic findings. Test sensitivity, specificity, and accuracy were statistically evaluated using one test and two tests at the levels of 50, 75, 100, 125, and 150 ng/mL of faecal hemoglobin in those patients with advanced polyps and colorectal cancer. The optimum cut-off test level for clinically significant neoplasia was determined using one test. RESULTS: The optimum cut-off value of q-FIT OC-Sensor for the detection of clinically significant neoplasia in our particular population was determined as 75 ng/mL using one test. This value provides an optimum proportion of 73% sensitivity (±95% CI 60.3% - 83.4%) and 90% specificity (±95% CI 86.8% - 92.8%), PPV and NPV were determined as 54.76% and 95.43% respectively. CONCLUSIONS: The first step in the implementation of q-FIT test in the screening program in our country is to determine the optimum cut-off level for a population, and to estimate the number of tests performed with respect to the optimum cost effectiveness and economical climate. Using one test, the optimum level of q-FIT OC-Sensor® in the Czech Republic was determined as 75 ng/mL. This study could serve as a model for further studies in other countries, where screening does not yet exist.

• MeSH
• časná detekce nádoru MeSH
• imunologické testy MeSH
• kolorektální nádory diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• okultní krev MeSH
• ROC křivka MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Cíl: Ověřit validitu a prediktivní hodnotu vybraných skríningových testů pro detekci polyneuropatie – The Michigan Neuropathy Screening Instrument (MNSI) a The Utah Early Neuropathy Scale (UENS), a skríningového testu pro detekci neuropatické bolesti – DN4 – u pacientů s prediabetem a časným diabetem mellitem 2. typu (preDM/eDM2). Soubory a metodika: Soubor 17 pacientů s preDM a 48 pacientů s eDM2 (s trváním do tří let) a kontrolní skupina 40 zdravých dobrovolníků bez poruchy glukózového metabolizmu byly extenzivně vyšetřeny se zaměřením na detekci neuropatie silných (LFN) a tenkých vláken (SFN). Výsledky: Možná diabetická periferní neuropatická bolest (DPNP) byla detekována u 15 preDM/eDM2 pacientů (23,1 %). DN4 prokázal schopnost diferencovat pacienty s DPNP a bez ní, optimální cut-off hodnota však byla nižší než doporučovaná (≥ 1 bodů). Pomocí MNSI I bylo možné odlišit nemocné s klinicky podporovanou SFN (cut-off > 1 bod), zatímco pomocí MNSI II bylo možné diferencovat nemocné s klinicky i laboratorně podporovanou LFN (p = 0,003; p < 0,001) při použití doporučovaného kritéria ≥ 2–≥ 3 body. Pomocí UENS bylo navíc možné diskriminovat i nemocné s klinicky podporovanou SFN (p = 0,038), nikoliv však nemocné s laboratorně podporovanou SFN. Závěry: Pomocí DN4 bylo možné detekovat nemocné s DPNP, při použití doporučovaných limitních hodnot má však spíše charakter konfirmačního než skríningového testu s vysokou specificitou a nižší senzitivitou. Pomocí MNSI I bylo možné diskriminovat nemocné s klinicky podporovanou SFN, avšak nikoli při použití doporučované hodnoty cut-off > 7 bodů. Pomocí MNSI II a UENS bylo možné u nemocných s preDM/eDM2 spolehlivě diskriminovat jedince s LFN a bez ní, pouze UENS však byl schopen diskriminovat nemocné s klinicky podporovanou SFN. Žádný z testů neprokázal dostatečnou validitu v detekci laboratorně podporované SFN.

Aim: To confirm the validity and predictive value of selected screening tests for neuropathy – The Michigan Neuropathy Screening Instrument (MNSI) and The Utah Early Neuropathy Scale (UENS), and a screening test for detection of neuropathic pain – DN4 – in a population of patients with prediabetes and early type 2 diabetes mellitus (preDM/eDM2). Patients and methods: Groups of 17 preDM and 48 eDM2 patients (with duration of disease <3 years), and a control group of 48 healthy subjects without impaired glucose metabolism were extensively evaluated with a focus on large fiber (LFN) and small fiber neuropathy (SFN). Results: Possible diabetic peripheral neuropathic pain (DPNP) was detected in 15 preDM/eDM2 patients (23.1%). DN4 significantly discriminated patients with and without DPNP, the optimal cut-off value being lower than recommended (≥1 point). MNSI I discriminated patients with and without clinically-based SFN (using cut-off >1 point), while MNSI II discriminated effectively patients with and without both clinically- and laboratory-based LFN (p = 0.003, p <0.001) using recommended cut-offs of ≥2–≥3 points. In addition, UENS discriminated patients with and without clinically-based SFN (p = 0.038) but not those with and without laboratory-based SFN. Conclusions: DN4 is able to discriminate patients with and without DPNP; the recommended cut-off values, however, provide high specificity but low sensiti­vity (i.e. attributes typical for a confirmatory, not a screening test). MNSI I discriminated patients with clinically-based SFN, although not when the recommended cut-off value of >7 points was used. Both MNSI II and UENS reliably discriminated preDM/eDM2 patients with and without LFN while only UENS discriminated patients with and without clinically-based SFN. Neither test was useful for detection of laboratory-based SFN.

• Klíčová slova
• polyneuropatie asociovaná s prediabetem, Impaired Fasting Glucose, diabetická periferní neuropatická bolest, the Utah Early Neuropathy Scale, the Michigan Neuropathy Screening Instrument, MDNS, DPNP, PEDAP, UENS, MNSI, DN4, neuropatie silných vláken,
• MeSH
• diabetes mellitus 2. typu MeSH
• diabetes mellitus MeSH
• dospělí MeSH
• hypertenze MeSH
• index tělesné hmotnosti MeSH
• klinické laboratorní techniky MeSH
• kouření MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuralgie MeSH
• neurologické vyšetření * klasifikace   MeSH
• neuropatie tenkých vláken MeSH
• nociceptivní bolest MeSH
• plošný screening MeSH
• polyneuropatie * diagnóza   MeSH
• porucha glukózové tolerance diagnóza   MeSH
• prediabetes MeSH
• prediktivní hodnota testů * MeSH
• průzkumy a dotazníky MeSH
• reprodukovatelnost výsledků * MeSH
• senioři MeSH
• senzitivita a specificita * MeSH
• statistika jako téma MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

OBJECTIVES: In diabetic patients, there is a discrepancy in guidelines for ankle-brachial index (ABI) screening for peripheral arterial disease (PAD). While diabetes organizations suggest the value of upper limit of normal ABI to be 1.3, cardiologists recommend 1.4. Also, guidelines recommend using the higher value of ankle pres-sure (HAP) but multiple recent studies propose the opposite (LAP). METHODS: In this prospective study, we performed ABI measurements in 62 diabetic patients. Results were calculated by comparing higher and lower values of ankle pressure to those of duplex ultrasound (stenosis ≥ 50 % was considered PAD). Special attention was paid to patients with high and non-measurable ABI.RESULTS: LAP ABI appears to be a preferable method for PAD screening in diabetics. The upper cut-off value of 1.4 yielded better results with sensitivity of 93 % and negative predictive value of 91 %. No limbs with ABI between 1.3 and 1.4 with signifi cant stenosis were found. However, using HAP for the upper cut-off captured additional PAD patients. PAD was abundant among patients with high or non-measurable ABI.CONCLUSIONS: LAP should be used for assessing low ABI (cut-off 0.9) while HAP for detecting the abnormally high ABI. The preferable high ABI cut-off is 1.4. Condition with abnormally high or non-measurable ABI should be considered as PAD (Tab. 3, Ref. 22). Text in PDF www.elis.sk.KEY WORDS: ankle-brachial index, diabetes, peripheral arterial disease, lower extremity arterial disease, cut-off.

• MeSH
• diabetické angiopatie diagnóza   MeSH
• lidé MeSH
• onemocnění periferních cév diagnóza   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• tlakový index kotník-paže * MeSH
• Check Tag
• lidé MeSH

Cíl: Analyzovat korelaci mezi hodnotami D-dimerů a pozitivním nálezem plicní embolie na CT-angiografii. Stanovení cut-off hodnoty D-dimerů, která by vedla ke snížení počtu vyšetření na CT-angiografii. Materiály a metody: Do analýzy byli zařazeni pacienti, kteří měli v krevních testech prokázány pozitivní hodnoty D-dimerů a byly vyšetřeni na CT-angiografii z období prosinec 2019 až leden 2020. Analyzován byl vztah mezi hodnotou D-dimerů a nálezem plicní embolie na CT-angiografii. Do analýzy bylo zařazeno 91 konsekutivních pacientů (46 žen, 64,4 ± 18,8 let) vyšetřených od prosince 2019 do ledna 2020. Výsledky: Průměrná hodnota D-dimerů u pacientů s prokázanou embolií na CT byla statisticky významně vyšší než u pacientů bez embolie (7,46 vs. 2,93mg/l; p <0,001). Z celkového počtu pacientů vyšetřených na CT byla plicní embolie potvrzena u 21 (23%). Neprokázali jsme statisticky významný rozdíl ve výskytu plicní embolie u jednoho z pohlaví (52% ženy vs. 48% muži; p = 1,000), ani vztah věku a výskytu plicní embolie (64,2 vs. 64,5 let; p = 0,981). Na základě ROC analýzy jsme stanovili vysokou pravděpodobnost negativní CT-angiografie při hodnotě D-dimerů do 1,7 mg/l (negativní prediktivní hodnota 95,7%). Dále jsme stanovili hodnotu D-dimerů 3,5mg/l, od níž je pravděpodobnost plicní embolie na CT vysoká (specificita 81,4%). Závěr: Na základě retrospektivní analýzy pacientů s naměřenými hodnotami D-dimerů a objektivizací nálezu plicní embolie na CT-angiografii jsme prokázali velmi nízkou pravděpodobnost plicní embolie při hodnotách D-dimerů do 1,7mg/l. Zároveň jsme prokázali, že při hodnotách nad 3,5mg/l je pravděpodobnost plicní embolie vysoká.

Aim: The analysis of the correlation between D-dimer and positive finding of pulmonary embolism on CT-angiography. Determination of the cut-off value of D-dimers, which would lead to a reduction in the number of examinations on CT-angiography. Materials and methods: Patients who had positive D-dimer values in their blood tests and were examined using CT-angiography were included in the analysis. The relationship between the D-dimer value and the finding of pulmonary embolism on CT-angiography was analyzed. The analysis included 91 consecutive patients (46 women, 64,5 ± 18,8 years) examined from December 2019 to January 2020. Results: The mean value of D-dimers in patients with proven pulmonary embolism on CT was statistically significantly higher than in patients without embolism (7,46 vs 2,93mg/l; p <0,001). Of the total number of patients examined on CT, pulmonary embolism was confirmed in 21 (23%). We did not show a statistically significant difference in the incidence of pulmonary embolism in one sex (52% female vs 48% male; p = 1,000), nor the relationship between age and the incidence of pulmonary embolism (64,2 vs 64,5 years; p = 0,981). Based on ROC analysis, we determined a high probability of negative CT-angiography at the value of D-dimers up to 1,7mg/l (negative predictive value 95,7%). We also determined the value of D-dimers 3,5mg/l, from which the probability of pulmonary embolism on CT is high (specificity 81,4%). Conclusion: Based on a retrospective analysis of patients with measured values of D-dimers and objectification of the finding of pulmonary embolism on CT-angiography, we demonstrated a very low probability of pulmonary embolism at D-dimer values up to 1,7mg/l. We also showed that at values above 3,5mg/l, the probability of pulmonary embolism is high.

• Klíčová slova
• pulmonary embolism, D-dimer, CT-angiography, plicní embolie, D-dimery, CT-angiografie,
• MeSH
• CT angiografie * statistika a číselné údaje   MeSH
• fibrin-fibrinogen - produkty degradace MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní embolie * diagnostické zobrazování   diagnóza   MeSH
• prediktivní hodnota testů MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• pozorovací studie MeSH

• MeSH
• embryonální struktury MeSH
• genetické markery diagnostické užití   MeSH
• mapování chromozomů MeSH
• nemoci plodu MeSH
• prospektivní studie MeSH
• vrozené vady MeSH