Celiac disease (CD) has in recent years become understood as a disease in which the importance of complete digestion of gliadin is essential for safe management of patients. Lately, the use of enzyme therapy for treatment of CD has gained wider acceptance as an adjunct to the gluten-free diet. A closer examination of Non-Celiac Gluten Sensitivity (NCGS) is warranted to determine if enzyme supplementation could be beneficial for individuals with this condition. Incomplete digestion of gluten produces toxic and/or immunologically active peptides which are implicated in both CD and in NCGS. These peptides are from a region close to the N-terminus of A-gliadin and contain serine or tyrosine residues. NCGS is caused by certain serine-containing peptides in A-gliadin and particularly those near the N-terminus. Peptide 11-19 is the most active of these peptides in vitro but may not be involved in cell-mediated immune reactions in CD. These reactions are related to tyrosine-containing peptides. Further along the chain is peptide 75-86, the most tissue damaging of the A-gliadin peptides in CD patients. This peptide is a tyrosine-containing peptide where damage caused to mucosal tissue is greater in CD than in NCGS. Hence, although CD and NCGS are both caused by gluten, the pathogenesis of the diseases has different mechanisms. However, both serine-containing and tyrosine-containing peptides are attacked by caricain, the protective enzyme in GluteGuard, thus rendering both types of toxic peptides harmless to the intestinal mucosa of susceptible individuals. Just as has been seen with Dermatitis Herpetiformis (DH), gluten is becoming a focus for several conditions when the neurological effects of gluten need to be considered.

BACKGROUND: Mucosal visualization during upper gastrointestinal (UGI) endoscopy can be impaired by the presence of foam, bubbles, and mucus. Some UGI endoscopy visibility scales have been proposed but have not undergone multicenter validation. This study aimed to develop and validate the Gastroscopy RAte of Cleanliness Evaluation (GRACE) scale. METHODS: A multicenter, international, cross-sectional study was conducted. The GRACE scale is based on a score from 0 (worst) to 3 (excellent) for esophagus, stomach, and duodenum, for a total ranging from 0 to 9. In phase 1, four expert endoscopists evaluated 60 images twice, with a 2-week interval between rounds; in phase 2, the same 60 images were scored twice by one expert and one nonexpert endoscopist from 27 endoscopy departments worldwide. For reproducibility assessment and real-time validation, the scale was applied to consecutive patients undergoing gastroscopy at each center. RESULTS: On internal validation, interobserver agreement was 0.81 (95 %CI 0.73-0.87) and 0.80 (95 %CI 0.72-0.86), with reliability of 0.73 (95 %CI 0.63-0.82) and 0.72 (95 %CI 0.63-0.81), in the two rounds, respectively. On external validation, overall interobserver agreement was 0.85 (95 %CI 0.82-0.88) and reliability was 0.79 (95 %CI 0.73-0.84). In real-time evaluation, the overall proportion of correct classifications was 0.80 (95 %CI 0.77-0.82). CONCLUSIONS: The GRACE scale showed good interobserver agreement, reliability, and validity. The widespread use of this scale could enhance quality and standardize the assessment of mucosal cleanliness during UGI endoscopy, pushing endoscopists to strive for excellent visibility and reducing the risk of missed lesions.

• MeSH
• dospělí MeSH
• duodenum MeSH
• gastroskopie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• odchylka pozorovatele * MeSH
• průřezové studie MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• žaludeční sliznice MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• validační studie MeSH

• Klíčová slova
• dentální hygiena, onkologický pacient,
• MeSH
• čištění zubů MeSH
• mukozitida prevence a kontrola   MeSH
• nádory komplikace   MeSH
• orální hygiena metody   MeSH
• parodontitida prevence a kontrola   MeSH
• radioterapie škodlivé účinky   MeSH
• zubní hygienici MeSH
• zubní kaz prevence a kontrola   MeSH

BACKGROUND: A number of recent studies have shown that the intestinal microbiome, part of the brain-gut axis, is implicated in the pathophysiology of multiple sclerosis. An essential part of this axis, is the intestinal barrier and gastrointestinal disorders with intestinal barrier dysregulation appear to be linked to CNS demyelination, and hence involved in the etiopathogenesis of multiple sclerosis (MS). OBJECTIVE: The aim of this study was to evaluate the integrity of the intestinal barrier in patients with clinically definite multiple sclerosis (CDMS) and clinically isolated syndrome (CIS) using two serum biomarkers, claudin-3 (CLDN3), a component of tight epithelial junctions, and intestinal fatty acid binding protein (I-FABP), a cytosolic protein in enterocytes. METHODS: Serum levels of CLDN3 in 37 MS patients and 22 controls, and serum levels of I-FABP in 46 MS patients and 51 controls were measured using commercial ELISA kits. Complete laboratory tests excluded the presence of gluten-related disorders in all subjects. Thirty MS patients received either disease-modifying drugs (DMD), immunosuppression (IS) or corticosteroid treatment. RESULTS: CLDN3 levels were only significantly higher in the MS patients treated with DMD or IS compared to the control group (P=0.006). There were no differences in I-FABP serum levels between the groups. Serum CLDN3 levels did not correlate with serum I-FABP levels in CDMS, in CIS patients or controls. CONCLUSIONS: In multiple sclerosis patients, the intestinal epithelium may be impaired with increased permeability, but without significant enterocyte damage characterized by intracellular protein leakage. Based on our data, CLDN3 serum levels appear to assess intestinal dysfunction in MS patients but mainly in treated ones.

• MeSH
• biologické markery * krev   MeSH
• claudin-3 * metabolismus   MeSH
• dospělí MeSH
• funkce střevní bariéry MeSH
• lidé středního věku MeSH
• lidé MeSH
• permeabilita * MeSH
• proteiny vázající mastné kyseliny * krev   MeSH
• roztroušená skleróza * patofyziologie   metabolismus   krev   MeSH
• střevní sliznice metabolismus   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Radioterapie hlavy a krku zpravidla probíhá několik týdnů a v její druhé polovině většina pacientů zaznamená bolest způsobenou mukositidou a dermatitidou. Bolest se stupňuje s množstvím absolvovaných frakcí, avšak pro efektivitu terapie je podstatné ozařování nepřerušovat, a proto jsou potřebné opakované úpravy analgetické medikace. Vhodným přístupem je „sendvičová metoda“ – střídavé přidávání analgetik a koanalgetik. Při mukositidě není možné využít všechny lékové formy analgetik, a tak se uchylujeme i k off-label postupům.

Radiotherapy of the head and neck usually takes place over several weeks and in the second half most patients experience pain due to mucositis and dermatitis. The pain increases with the number of fractions completed. However, it is essential for the effectiveness of the therapy not to interrupt radiation, and therefore repeated adjustments of analgesic medication are necessary. A suitable approach is the sandwich method: alternating addition of analgesics and co-analgesics. In mucositis, it is not possible to use all dosage forms of analgesics and therefore we resort to off-label approaches.

• MeSH
• analgetika terapeutické užití   MeSH
• bolest * farmakoterapie   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• nádory hlavy a krku * komplikace   radioterapie   MeSH
• průlomová bolest farmakoterapie   MeSH
• radioterapie škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Proton beam therapy using pencil beam scanning is an advanced radiotherapy technique that utilises proton beams to precisely target tumours. It is known for its enhanced ability in sparing healthy tissue and potentially reducing toxicity. Clinical experience with pencil beam scanning in the treatment of mediastinal Hodgkin lymphoma remains limited. PATIENTS AND METHODS: This study aimed to evaluate the toxicity and outcomes of a prospectively observed cohort. A total of 162 patients were irradiated between May 2013 and December 2020, with a median age of 32 years (range: 18.4-79.2) and followed up until April 2024. The median applied dose was 30 GyE (range: 20-40). Deep inspiration breath hold was used in 146 patients to enhance targeting precision. RESULTS: The disease-free survival, overall survival and local control rates were 95.1 %, 98.8 % and 98.8 %, respectively. The median follow-up was 59.1 months (range: 4-120.1). The most common acute toxicities observed were oesophageal and skin toxicity. Grade 1 oesophageal mucositis occurred in 76 patients (47 %), grade 2 in 16 patients (10 %). Dermatitis of grade 1 and 2 was observed in 65 (40 %) and 4 (3 %) patients respectively. Grade 1 pulmonary toxicity presented in 8 patients (4.9 %), and grade 2 in one patient (0.6 %). The most predominant late toxicity was grade 2 hypothyroidism in 37 patients (23 %). Three patients (1.8 %) underwent coronary interventions during follow-up, and one patient was diagnosed with hepatocellular carcinoma 3 months post-RT. No unexpected acute or late toxicities were observed. CONCLUSION: Proton beam therapy using pencil beam scanning is a safe and effective technique in terms of toxicity and local control, even when irradiating mediastinal targets.

• MeSH
• celková dávka radioterapie MeSH
• dospělí MeSH
• Hodgkinova nemoc * radioterapie   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory mediastina * radioterapie   mortalita   MeSH
• prospektivní studie MeSH
• protonová terapie * škodlivé účinky   metody   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Předložená kazuistika popisuje případ pacientky s metastazujícím maligním melanomem anorekta. Vzhledem k synchronní generalizaci do lymfatických uzlin a plic, a tedy nemožnosti kurativního chirurgického či radioterapeutického řešení, byla pacientka léčena několika liniemi systémové léčby. V souladu s doporučenými postupy a též pro BRAF negativitu melanomu byla v 1. linii léčby indikována kombinovaná imunoterapie ipilimumabem a nivolumabem. Následně pro opakované progrese onemocnění absolvovala pacientka ještě dvě linie konvenční chemoterapie a poté s ohledem na metastatický rozsev do mozku ještě 3 cykly léčby temozolomidem. Mozkové metastázy byly ošetřeny Leksellovým gama nožem (LGN), později byla pro další progresi využita možnost paliativního celomozkového ozáření (WBRT - whole brain radiotherapy). V závěru života pacientka podstoupila paliativní radioterapii primárního ložiska anorekta s cílem ulevit od obtěžujících symptomů. Dále využívala ambulance hojení ran a podpůrnou péči paliativní kliniky, později domácího hospicu. Pacientka zemřela 33 měsíců od stanovení diagnózy metastazujícího melanomu a 12 měsíců od zjištění mozkových metastáz.

The presented case report describes the case of a patient with mucosal primary metastasizing malignant melanoma of the anorectum. Due to the synchronous generalization to the lymph nodes and lungs and therefore the impossibility of a curative surgical or radiotherapy solution, the patient was treated with several lines of systemic treatment. In accordance with guidelines and for BRAF negativity, combined immunotherapy with ipilimumab and nivolumab was indicated in the 1st line of treatment. Subsequently, due to repeated progression of the disease, the patient completed two more lines of conventional chemotherapy and then, regarding metastatic spread to the brain, three more cycles of temozolomide treatment. Brain metastases were treated with the Leksell Gamma Knife (LGN), later for further progression the palliative whole brain radiotherapy (WBRT) was used. At the end of her life, the patient underwent palliative radiotherapy of the primary anorectal lesion with the aim of relieving the bothersome symptoms, she used a wound healing clinic and supportive care through a palliative clinic, later a home hospice. The patient died 33 months after the diagnosis of metastatic melanoma and 12 months after the diagnosis of brain metastases.

• MeSH
• dakarbazin farmakologie   terapeutické užití   MeSH
• imunoterapie metody   MeSH
• ipilimumab farmakologie   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• melanom chirurgie   farmakoterapie   radioterapie   MeSH
• metastázy nádorů MeSH
• nádory anu * chirurgie   farmakoterapie   radioterapie   MeSH
• nemoci mozku radioterapie   MeSH
• nivolumab farmakologie   terapeutické užití   MeSH
• paliativní péče metody   MeSH
• protokoly protinádorové léčby MeSH
• smrt MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Digestivní endoskopie, klíčová metoda pro diagnostiku a léčbu onemocnění gastrointestinálního traktu, se neustále vyvíjí. Novinky v této oblasti zahrnují pokroky v technologii, nové diagnostické techniky a inovace v terapeutických přístupech. Moderní endoskopická zařízení nyní nabízejí vyšší rozlišení obrazu díky pokročilé optice a kamerovým systémům, což umožňuje lépe identifikovat a charakterizovat patologické změny v gastrointestinálním traktu. Nový vývoj technik jako je endoskopická ultrasonografie (EUS), rozšiřuje možnosti diagnostiky tím, že umožňuje vizualizaci hloubkových struktur a vyšetření okolních tkání. Cholangioskopie vhodně doplňuje endoskopickou retrográdní cholangiopankreatikografii (ERCP) v diagnostice biliárních stenóz nejasné etiologie a umožňuje jejich cílenou biopsii. Enteroskopie přinesla významné rozšíření diagnostických a terapeutických postupů zaměřených na tenké střevo. V terapeutických přístupech zaznamenáváme rozvoj minimálně invazivních metod, které umožňují odstranění lézí a léčbu různých gastrointestinálních onemocnění bez nutnosti otevřené chirurgické intervence. Tyto inovace nejen zvyšují přesnost diagnostiky, ale také rozšiřují možnosti léčby, čímž přispívají k lepší péči o pacienty. Budoucnost digestivní endoskopie bude pravděpodobně zaměřena na další zlepšení endoskopických technik s cílem optimalizovat výsledky a minimalizovat invazivitu, a také využití umělé inteligence.

Digestive endoscopy, a key method for the diagnosis and treatment of diseases of the gastrointestinal tract, is constantly evolving. New developments in this field include advances in technology, new diagnostic techniques, and innovations in therapeutic approaches. Modern endoscopic equipment now offers higher image resolution thanks to advanced optics and camera systems, which allow better identification and characterization of pathological changes in the gastrointestinal tract. New techniques, such as endoscopic ultrasonography (EUS), are expanding diagnostic capabilities by allowing visualization of deep structures and examination of surrounding tissues. Cholangioscopy appropriately complements endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of biliary strictures of uncertain etiology and allows their targeted biopsy. Enteroscopy has brought a significant extension of diagnostic and therapeutic procedures targeting the small intestine. In therapeutic approaches, we have seen the development of minimally invasive methods that allow the removal of lesions and the treatment of various gastrointestinal diseases without the need for open surgical intervention. These innovations not only increase the accuracy of diagnosis but also expand treatment options, thus contributing to better patient care. The future of digestive endoscopy will likely focus on further improvements in endoscopic techniques to optimize outcomes and minimize invasiveness.

• MeSH
• endoskopická mukózní resekce metody   přístrojové vybavení   MeSH
• endoskopie trávicího systému * klasifikace   metody   přístrojové vybavení   MeSH
• endosonografie klasifikace   metody   MeSH
• gastrointestinální endoskopie klasifikace   metody   MeSH
• lidé MeSH
• nemoci trávicího systému * diagnostické zobrazování   patologie   terapie   MeSH
• žlučové cesty diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure that has become a first-line treatment for esophageal achalasia and other esophageal spastic disorders. Structured training is essential to optimize the outcomes of this technique. The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in POEM. This Position Statement presents the results of a systematic review of the literature and a formal Delphi process, providing recommendations for an optimal training program in POEM that aims to produce endoscopists competent in this procedure. In a separate document (POEM curriculum Part II), we provide technical guidance on how to perform the POEM procedure based on the best available evidence. 1: POEM trainees should acquire a comprehensive theoretical knowledge of achalasia and other esophageal motility disorders that encompasses pathophysiology, diagnostic tool proficiency, clinical outcome assessment, potential adverse events, and periprocedural management. 2: Experience in advanced endoscopic procedures (endoscopic mucosal resection and/or endoscopic submucosal dissection [ESD]) is encouraged as a beneficial prerequisite for POEM training. 3: ESGE suggests that POEM trainees without ESD experience should perform an indicative minimum number of 20 cases on ex vivo or animal models before advancing to human POEM cases with an experienced trainer. 4: ESGE recommends that the trainee should observe an indicative minimum number of 20 live cases at expert centers before starting to perform POEM in humans. 5: The trainee should undertake an indicative minimum number of 10 cases under expert supervision for the initial human POEM procedures, ensuring that trainees can complete all POEM steps independently. 6: ESGE recommends avoiding complex POEM cases during the early training phase. 7: POEM competence should reflect the technical success rate, both the short- and long-term clinical success rates, and the rate of true adverse events. 8: A POEM center should maintain a prospective registry of all procedures performed, including patient work-up and outcomes, procedural techniques, and adverse events.

• MeSH
• achalázie jícnu * chirurgie   MeSH
• delfská metoda MeSH
• endoskopické operace přirozenými otvory * výchova   MeSH
• gastrointestinální endoskopie * výchova   MeSH
• klinické kompetence MeSH
• kurikulum * MeSH
• lidé MeSH
• myotomie * výchova   metody   MeSH
• pyloromyotomie * výchova   MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH
• systematický přehled MeSH
• Geografické názvy
• Evropa MeSH

This study aimed to explore the function of Seleno-chitooligosaccharide (SOA) on the intestinal barrier through regulation of inflammatory cytokines, tight junction protein, and gut microbiota in mice. The results of ELISA assay demonstrated that SOA significantly increased the levels of IL-2, IL-10, and IFN-γ in serum and ileum. Meanwhile, SOA increased the levels of IL-4 in the ileum (p < 0.05). In addition, Diamine Oxidase (DAO) concentration was decreased in ileum by SOA treatments (p < 0.05). The administration of SOA significantly upregulated the expression of ZO-1 and Occludin in the ileum (p < 0.05). By 16S rDNA sequencing, reduced ratio of Bacillota/Bacteroidota was observed in SOA treated mice. Within the phylum of Bacteroidota, SOA increased the relative abundance of Deferribacterota, uncultured Bacteroidales bacterium, and Bacteroides. Within the phylum of Bacillota, increased relative abundance of Erysipelatoclostridium and Lachnoclostridium, and reduced relative abundance of Ruminococcaceae UCG-010 were observed with SOA supplement. In summary, SOA has the potential to modulate the function of intestinal barrier function and prevent intestinal diseases.

• MeSH
• chitin farmakologie   analogy a deriváty   metabolismus   MeSH
• chitosan MeSH
• cytokiny * metabolismus   MeSH
• funkce střevní bariéry MeSH
• ileum mikrobiologie   účinky léků   metabolismus   MeSH
• myši MeSH
• oligosacharidy * farmakologie   metabolismus   MeSH
• proteiny těsného spoje * metabolismus   genetika   MeSH
• střevní mikroflóra * účinky léků   MeSH
• střevní sliznice * metabolismus   účinky léků   mikrobiologie   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH