BACKGROUND/AIM: Cemiplimab in patients with non-small cell lung cancer (NSCLC) with PD-L1 (programmed death ligand type 1) expression ≥50% showed a significant improved overall survival (OS) with increasing expression of PD-L1. To our knowledge there exist no similar data published for pembrolizumab regarding the increased OS in relation to the PD-L1 expression. Therefore, the objective of our study was to determine whether improvement in OS reflects increased expression levels of PD-L1 (≥50%) in patients with NSCLC. PATIENTS AND METHODS: Retrospective data from 9 Czech and 1 Polish comprehensive oncology Centers were used. All patients with stage IV NSCLC and PD-L1 expression ≥50% treated with pembrolizumab in daily practice were included. The groups of patients according to the expression of PD-L1 were determined as follows: PD-L1 50-59%, 60-69%, 70-79%, 80-89% and 90-100%. The log-rank test and the Cox regression model were used to compare survival between study groups. RESULTS: A total of 617 patients were included in the study. We did not observe a statistically significant difference in OS between groups of patients with different levels of PD-L1 expression in the pooled comparison (p=0.445). Furthermore, we did not observe a statistically significant difference even when comparing OS in patients with PD-L1expression of 50-59% (reference) with the group of other patients according to the level of expression of PD-L1 in the Cox regression model including the effect covariates. CONCLUSION: PD-L1 expression showed no significant effect on OS in patients with NSCLC with PD-L1≥50% treated with pembrolizumab.
- MeSH
- antigeny CD274 * metabolismus genetika MeSH
- dospělí MeSH
- humanizované monoklonální protilátky * terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádorové biomarkery metabolismus MeSH
- nádory plic * farmakoterapie mortalita metabolismus patologie genetika MeSH
- nemalobuněčný karcinom plic * farmakoterapie mortalita metabolismus patologie genetika MeSH
- prognóza MeSH
- protinádorové látky imunologicky aktivní terapeutické užití MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů 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
BACKGROUND: Total hip (THA) or knee (TKA) arthroplasty is still a traumatic and challenging operation that induces inflammation, with a particularly high risk of acute-phase reaction. The aim of this study was to predict the likelihood of implant-associated complications during the preoperative and postoperative course. METHODS: The prospective observational, non-interventional study of patients diagnosed with primary knee or hip osteoarthrosis undergoing THA or TKA during the study period was conducted. The inflammatory and malnutrition parameters were collected for each patient one day before surgery, two days after surgery, and in outpatient follow-up. RESULTS: Of 159 patients analysed, 12 developed implant-associated complications. The albumin, prealbumin, Intensive Care Infection Score (ICIS), Nutritional Risk Index, and white blood cell counts were found to be potential predictors. Notably, preoperative albumin levels significantly differed between groups with and without complications (P-value = 0.042). CONCLUSION: Our study definitively shows that WBC, prealbumin, Nutritional Risk Index, ICIS as a novel marker, and significantly albumin, outperform C-reactive protein in predicting implant-associated complications in hip and knee arthroplasty.
- MeSH
- artróza kyčelních kloubů chirurgie MeSH
- biologické markery krev MeSH
- C-reaktivní protein metabolismus analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- pooperační komplikace * etiologie krev MeSH
- prealbumin metabolismus analýza MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sérový albumin analýza metabolismus MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Stage III non-small cell lung cancer (NSCLC) is a highly heterogeneous stage due to its subgroups (IIIA-IIIC) comprising both resectable and unresectable tumors. Accurate determination of the extent of the disease is essential for excluding stage IV and choosing the optimal treatment regimen. Whole body positron emission tomography and computed tomography scan (PET/CT) is recommended as an initial staging imaging in locally advanced NSCLC. Despite international guidelines for NSCLC diagnosis and treatment, they are not always adhered to due to various reasons. Even in such a groundbreaking study, the phase 3 trial PACIFIC investigating the efficacy of durvalumab as consolidation therapy in patients with stage III NSCLC PET/CT was not mandatory. With the premise that whole body PET/CT of the trunk is essential for diagnosing stage III NSCLC, we performed a retrospective study evaluating the relationship of the use of PET/CT versus conventional staging with CT of the chest and abdomen, in terms of survival. METHODS: This retrospective study of stage III NSCLC patients used the Czech lung cancer registry LUCAS, which was established in June 2018. As of the data export (up to February 9, 2022), a total of 703 patients were eligible for the analysis. Overall survival (OS) was compared using Kaplan-Meier analysis and a Cox regression model. Continuous variables were tested using the Mann-Whitney test, and categorical variables using the Pearson's Chi-square or Fisher's exact test. RESULTS: A total of 703 patients were included in the cohort with an average age of 69 years. PET/CT was performed on 354 patients, and conventional staging using chest and abdominal CT on 349 patients. The median OS among patients with PET/CT was 20.9 months [95% confidence interval (CI): 18.1-23.7], and it was statistically significantly higher (P<0.001) than among patients without PET/CT, where the median OS was 9.0 months (95% CI: 7.3-10.6). The observed effect of PET/CT was also statistically significant when comparing individual stages (IIIA, IIIB, IIIC). The multivariate Cox model confirmed the use of PET/CT as an independent prognostic factor. The most common reason for omission of PET/CT was the local or time unavailability of the examination. CONCLUSIONS: Omission of PET/CT can mean a significant decrement in survival for the patients in stage III NSCLC, likely due to poor staging and suboptimal treatment. Routine use of PET/CT is strictly recommended for the optimal management of stage III NSCLC patients even outside the high-income countries.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Implant-associated infection (IAI) is a potential complication following total hip (THA) or knee arthroplasty (TKA). The initial phase of the inflammatory process can be measured by applying one of the inflammatory blood parameters (IBP). This systematic review aims to assess the response of IBP to trauma caused by orthopedic surgery and evaluate the clinical utility of quantitative measurements of IBP as prognostic factors for infection. METHODS: All studies indexed in Ovid MEDLINE (PubMed), Ovid EMBASE, the Cochrane Library and the ISI Web of Science databases, from inception until January 31, 2020, were analyzed. Studies included were those on adults who underwent THA or TKA with minimum follow up of 30 days after surgery. In addition to minimum follow up, data on the prognostic factors for pre- or post-THA/TKA IAI were mandatory. The Quality Assessment of Diagnostic Accuracy tool (version 2) (QUADAS-2) and Standards for Reporting of Diagnostic Accuracy Studies guideline 2015 (STARD) were used for quality assessment. RESULTS: Twelve studies fulfilled the inclusion and exclusion criteria. C-reactive protein was analyzed in seven studies, interleukin-6 in two studies and erythrocyte sedimentation rate in eight studies. White blood cell count and procalcitonin were analyzed in the only study. The overall quality of included studies was low. A potential for other cytokines (IL-1ra, IL-8) or MCP-1 was observed. CONCLUSIONS: This is the first systematic review of IBP response to orthopedic surgery which identified some IBP for pre/post-operative screening, despite insufficient data supporting their prognostic potential for patient risk stratification.
- Publikační typ
- abstrakt z konference MeSH
Úvod: Antibiotika (ATB) jsou klíčové léčivé přípravky a mají nezpochybnitelné využití. Naneštěstí zejména neracionální používání ATB vede k rizikům především nežádoucích účinků, interakcí a vzniku rezistence. Cílem této práce bylo analyzovat spotřebu ATB pro systémové použití v České republice (ČR) v letech 2005-2019 a přinést závěry pro klinickou praxi. Metodika: Analýza spotřeby ATB pro systémové použití probíhala jako longitudinální retrospektivní analýza dat z databáze Státního ústavu pro kontrolu léčiv v letech 2005-2019 za použití standardní metodiky pro studium spotřeby léčiv typu DUR (Drug Utilization Review). Spotřeba ATB se vypočítala jako definované denní dávky (DDD) jednotlivých ATB na tisíc obyvatel za den (TID). Analyzována byla celková spotřeba ATB pro systémové použití v jednotlivých letech. Druhotně byly sledovány spotřeby pro jednotlivé zástupce nebo podskupiny a vyhodnoceny relativní indikátory kvality spotřeb ATB. Data byla popsána deskriptivní statistikou. Výsledky: Nejvyšší spotřeba ATB pro systémové použití byla zaznamenána v roce 2015, kdy dosáhla hodnoty 19,3338 DDD/TID. Nejpoužívanější skupinou ATB v průběhu celého sledovaného období byla β‑laktamová ATB (peniciliny). Nejvýznamnější změna spotřeby za sledované období proběhla ve skupině fluorochinolonů, kde byl pokles z roku 2005 do roku 2019 více než 2násobný. Zejména viditelný byl trend poklesu spotřeby norfloxacinu, který nastal v roce 2013. Nárůst ve spotřebě ATB byl sledován především u meropenemu, vankomycinu, cefuroxim‑axetilu, skupiny chráněných penicilinů a cefalosporinů II. a III. generace. Závěr: V celkovém hodnocení nepatřila ČR mezi státy s vysokou spotřebou ATB a četnějšími negativními výsledky stran relativních indikátorů kvality spotřeb ATB. V ČR docházelo zejména k možnému neracionálnímu nahrazování některých ATB a nárůstu spotřeby některých širokospektrých ATB.
Introduction: Antibiotics (ATB) are essential medicines and have unquestionable uses. Unfortunately, the irrational use of ATB leads to the risks of adverse effects, interactions, and the development of drug resistance. This study aimed to analyse ATB consumption for systemic use in the Czech Republic (CR) in 2005-2019 and provide conclusions for clinical practice. Methods: The analysis of ATB consumption for systemic use was performed as a longitudinal retrospective analysis of data from the State Institute for Drug Control database in the years 2005-2019 using the standard methodology for studying drug consumption of the DUR (Drug Utilization Review) type. ATB consumption was calculated as defined daily doses (DDD) of each ATB per thousand inhabitants per day (TID). The total consumption of ATB for systemic use in each year was analysed. Secondarily, consumption for individual representatives or subgroups was analysed and relative quality indicators of ATB consumption were evaluated. Results: The highest consumption of ATB for systemic use was observed in 2015 when it reached 19.3338 DDD/TID. β-lactam ATB (penicillins) was the most commonly used group of ATB throughout the study period. The most significant change in consumption over the period was in the fluoroquinolone group, where the decrease from 2005 to 2019 was more than 2-fold. The obvious was the downward trend in consumption of norfloxacin, which occurred in 2013. ATB consumption increased mainly for meropenem, vancomycin, cefuroxime-axetil, β-Lactamase-protected penicillins and the 2nd and 3rd generation cephalosporins. Conclusion: In the overall assessment, CR was not among the countries with high ATB consumption and frequent negative results in the relative quality indicators of ATB consumption. In particular, the possible irrational substitution of some ATB and an increase in the consumption of some broad-spectrum ATB was observed in CR.
- MeSH
- antibakteriální látky aplikace a dávkování MeSH
- antibiotická rezistence MeSH
- beta-laktamy aplikace a dávkování MeSH
- fluorochinolony aplikace a dávkování MeSH
- hodnocení spotřeby léčiv * trendy MeSH
- lékové interakce MeSH
- lidé MeSH
- longitudinální studie MeSH
- náhrada léků MeSH
- nežádoucí účinky léčiv MeSH
- nitrofurantoin aplikace a dávkování MeSH
- peniciliny aplikace a dávkování MeSH
- retrospektivní studie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
INTRODUCTION: Surgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty. METHODS AND ANALYSIS: A systematic review of randomised controlled trials, cross-sectional studies, case-control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings. ETHICS AND DISSEMINATION: No ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020147925.
- MeSH
- infekce chirurgické rány diagnóza epidemiologie etiologie MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- prognóza MeSH
- průřezové studie MeSH
- systematický přehled jako téma MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cíl studie: Zhodnocení provedení antibiotické profylaxe v chirurgii. Typ studie: Průřezová studie. Typ pracoviště: Zdravotnické zařízení lůžkové péče krajského typu. Materiál a metoda: Antibiotická profylaxe byla zhodnocena u pacientů ≥ 18 let, kteří v definovaném období podstoupili chirurgický výkon a současně vyjádřili svůj souhlas se zpracováním dat pro odborné účely. Data byla sbírána pomocí pře dem vytvořeného formuláře pro perioperační záznam antibiotické profylaxe (identifikace a pohlaví pacienta, informace o chirurgickém výkonu, název antibiotika, dávka antibiotika, čas podání a délka podávání antibiotika) a ze zdravotnické dokumentace. Nasbíraná data byla porovnána s dostupnými vědeckými poznatky a s interním standardem. Výsledky byly zpracovány deskriptivní statistikou. Výsledky: Studie se zúčastnilo 197 pacientů (103 mužů a 94 žen) v průměrném věku 56,5 let. Nejčastěji byl sledován uro logický výkon, a to u 43 (21,8 %) pacientů. Antibiotickou profylaxi obdrželo 125 (63,5 %) pacientů. Indikace antibiotické profylaxe odpovídala z 86,9 % standardu a z 88,9 % dostupným vědeckým poznatkům. U 52 % chirurgických výkonů byl podán cefazolin. Na základě podrobného hodnocení byly v současném interním standardu napříč obory identifikovány některé oblasti vhodné k revizi. Jedná se především o doplnění obecných zásad provedení antibiotické profylaxe, zo hlednění individuálních charakteristik pacienta a podrobnější specifikování jednotlivých výkonů dle chirurgických oborů. Závěr: V interním standardu antibiotické profylaxe byly identifikovány jisté rozdíly oproti dostupným vědeckým poznat kům. Určité odlišnosti oproti standardu i aktuálním poznatkům byly shledány i při hodnocení provedení profylaxe v praxi.
Objective: Evaluation of antibiotic prophylaxis in surgery. Design: Cross-sectional study. Setting: Regional healthcare facility. Material and methods: This study assessed patients (≥18 years old) who underwent a surgical operation in the defined period and agreed to participate in the study. Data were collected through the form for antibiotic prophylaxis perioperative record (identification and gender, information about surgical operation, choice of antibiotic, dose of antibiotic, time of administration and duration of it), and from the medical records. Collected data were compared with evidence-based medicine and internal hospital standards. The descriptive statistics were used for evaluation. Results: 197 patients (103 men and 94 women) with average age of 56.5 years attended the study. Urological procedure was most frequently observed in 43 (21.8%) patients. 125 (63.5%) patients received antibiotic prophylaxis. The indication of the antibiotic prophylaxis was correct in 86.9% with the internal hospital standards and in 88.9% with the evidence-based medicine. Cefazolin was administered in the 52% of surgical procedures. Based on the detailed evaluation, some areas for revision have been identified in the internal hospital standards. It is necessary to define the general principles for antibiotic prophylaxis, to consider individual patient characteristics and more detailed specification of the individual surgical operations. Conclusion: Some contradictions with the evidence-based medicine have been identified in the internal hospital standard for antibiotic prophylaxis. Certain differences from the internal hospital standards as well as evidence-based medicine have been found in the evaluation of antibiotic prophylaxis in practice.
