• Klíčová slova
• milvexian, žaludeční polypy,
• MeSH
• cévní mozková příhoda * farmakoterapie   prevence a kontrola   MeSH
• gabapentin farmakologie   terapeutické užití   MeSH
• genetické markery MeSH
• inhibitory protonové pumpy * škodlivé účinky   MeSH
• lidé MeSH
• nežádoucí účinky léčiv MeSH
• pánevní bolest * farmakoterapie   MeSH
• polypy etiologie   MeSH
• pyrimidiny farmakologie   terapeutické užití   MeSH
• randomizované kontrolované studie jako téma MeSH
• triazoly farmakologie   terapeutické užití   MeSH
• žaludek patologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

• MeSH
• analgetika MeSH
• anestetika lokální aplikace a dávkování   terapeutické užití   MeSH
• gabapentin aplikace a dávkování   terapeutické užití   MeSH
• kvalita života MeSH
• lidé MeSH
• lidokain aplikace a dávkování   terapeutické užití   MeSH
• postherpetická neuralgie * diagnóza   farmakoterapie   prevence a kontrola   MeSH
• senioři MeSH
• transdermální náplast MeSH
• vakcína proti pásovému oparu MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY: Our aim was to compare the effects of intraarticular and intravenous (IV) tranexemic acid (TXA) application on bleeding and complication rates in patients who underwent total knee arthroplasty (TKA). MATERIAL AND METHODS: Between 2017 and 2021, 406 patients who underwent TKA with 2 g of IV TXA and retrograde 1.5 g of TXA applied through the drain were included in the study. Of the patients, 206 were in the IV TXA group. Preoperative and postoperative hemoglobin levels, drain output, BMI, ASA score, blood loss, and the number of transfused patients were recorded. Complications such as symptomatic venous thromboembolism were also recorded. RESULTS: There was no significant difference between the two groups in terms of age, sex, American Society of Anesthesiologists (ASA) score, or BMI (p = 0.68, 0.54, 0.28, 0.45). Total drain output and blood loss were significantly higher in the IV TXA group than in the intraarticular TXA group (p < 0.0001, p < 0.0001). Eighteen patients in the IV TXA group and 1 patient in the intraarticular TXA group received a blood transfusion (p < 0.0001). There was no difference between the two groups in terms of preoperative hemoglobin or platelet count (p = 0.24). However, postoperative hemoglobin level was higher in the patients who received intraarticular TXA (p=0.0005). More thromboembolism events were seen in the IV TXA group (p < 0.0001). CONCLUSIONS: Intraarticular TXA application reduces blood loss more than IV application, reduces the blood transfusion rate, and causes fewer complications. KEY WORDS: tranexemic acid, total knee arthroplasty, intraarticular injection, blood loss, blood transfusion.

• MeSH
• antifibrinolytika * aplikace a dávkování   MeSH
• injekce intraartikulární MeSH
• intravenózní podání MeSH
• konstrikce MeSH
• krevní transfuze statistika a číselné údaje   MeSH
• krvácení při operaci * prevence a kontrola   MeSH
• kyselina tranexamová * aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační krvácení prevence a kontrola   etiologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• totální endoprotéza kolene * metody   škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

• Klíčová slova
• syndrom bolestiplných dolních končetin a pohyblivých prstců,
• MeSH
• bolest diagnóza   patologie   MeSH
• dolní končetina * patologie   MeSH
• dospělí MeSH
• gabapentin terapeutické užití   MeSH
• lidé MeSH
• nemoci nervového systému * diagnóza   MeSH
• pohybové poruchy MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Kožní pigmentace závisí na syntéze a ukládání melaninu produkovaného melanocyty v epidermis. Aktivita melanocytů spolu s typem a rozložením melaninů je hlavním faktorem, který ovlivňuje rozmanitost kožní pigmentace. Tmavý melanin působí jako ochrana před škodlivými účinky ultrafialového (UV) záření tím, že je absorbuje a chrání buňky před poškozením způsobným slunečním světlem. UV záření aktivuje kožní melanocyty k vyvolání další pigmentace (tj. „cesta opálením“). Dobře charakterizovaná dráha MSH/MC1R-cAMP-MITF reguluje melanogenezi vyvolanou UV zářením. Farmakologická aktivace této dráhy (tzn. „opalování bez slunce“) představuje potenciální strategii prevence rakoviny kůže, zejména u osob se světlou kůží nebo fototypem I, které se po vystavení UV záření špatně opalují v důsledku inaktivujících polymorfismů MC1R. K hyperpigmentaci kůže může docházet také v důsledku zánětlivých procesů a dermatologických poruch, např. melasma či pozánětlivé pigmentace. Poruchy hyperpigmentace, pozánětlivé pigmentové změny mohou představovat pro osoby různých etnik významné kosmetické problémy. Přírodní složky získávají na popularitě jako alternativní, bezpečné a účinné lokální depigmentační prostředky. V tomto článku se zabýváme melanogenezí a látkami, které na tuto cestu cílí.

Skin pigmentation is the result of melanin produced by melanocytes in the epidermis. The activity of melanocytes, together with the type and distribution of melanin, is a major factor influencing the diversity of skin pigmentation. Dark melanin acts as protection against the harmful effects of ultraviolet (UV) radiation, including photoaging and skin cancer. UV radiation, in turn, activates skin melanocytes to induce further pigmentation (i.e., the "tanning pathway"). The well-characterized MSH/MC1R-cAMP-MITF pathway regulates UV-induced melanogenesis. Pharmacological activation of this pathway (i.e. "sunless tanning") represents a potential strategy for skin cancer prevention, especially in light-skinned or phototype I individuals who tan poorly after UV exposure due to inactivating MC1R polymorphisms. Hyperpigmentation can also occur due to inflammatory processes and dermatological disorders such as melasma. Hyperpigmentation disorders such as melasma, post-inflammatory pigmentary changes and lentigo are significant cosmetic problems for people of different ethnicities. Natural ingredients are gaining popularity as alternative, safe and effective topical depigmenting agents. In this article, we discuss melanogenesis and agents that target this pathway.

• MeSH
• hydrochinony farmakologie   terapeutické užití   MeSH
• hyperpigmentace * diagnóza   farmakoterapie   MeSH
• kožní nemoci farmakoterapie   MeSH
• kyselina tranexamová terapeutické užití   MeSH
• lidé MeSH
• retinoidy farmakologie   terapeutické užití   MeSH
• ultrafialové záření škodlivé účinky   MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Although intravenous tranexamic acid is used in cardiac surgery to reduce bleeding and transfusion, topical tranexamic acid results in lower plasma concentrations compared with intravenous tranexamic acid, which may lower the risk of seizures. We aimed to determine whether topical tranexamic acid reduces the risk of in-hospital seizure without increasing the risk of transfusion among cardiac surgery patients. METHODS: We conducted a multicenter, double dummy, blinded, randomized controlled trial of patients recruited by convenience sampling in academic hospitals undergoing cardiac surgery with cardiopulmonary bypass. Between September 17, 2019, and November 28, 2023, a total of 3242 patients from 16 hospitals in 6 countries were randomly assigned (1:1 ratio) to receive either intravenous tranexamic acid (control) through surgery or topical tranexamic acid (treatment) at the end of surgery. The primary outcome was seizure, and the secondary outcome was red blood cell transfusion. After the last planned interim analysis, when 75% of anticipated participants had completed follow up, the data and safety monitoring board recommended to terminate the trial, and upon unblinding, the operations committee stopped the trial for safety. RESULTS: Among 3242 randomized patients (mean age, 66.0 years; 77.7% male), in-hospital seizure occurred in 4 of 1624 patients (0.2%) in the topical group, and 11 of 1628 patients (0.7%) in the intravenous group (absolute risk difference, -0.5% [95% CI, -0.9 to 0.03]; P=0.07). Red blood cell transfusion occurred in 570 patients (35.1%) in the topical group and in 433 (26.8%) in the intravenous group (absolute risk difference, 8.3% [95% CI, 5.2-11.5]; P=0.007). The absolute risk difference in transfusion of ≥4 units of red blood cells in the topical group compared with the intravenous group was 8.2% (95% CI, 3.4-12.9). CONCLUSIONS: Among patients undergoing cardiac surgery, topical administration of tranexamic acid resulted in an 8.3% absolute increase in transfusion without reducing the incidence of seizure, compared with intravenous tranexamic acid. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03954314.

• MeSH
• antifibrinolytika * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• aplikace lokální * MeSH
• dvojitá slepá metoda MeSH
• intravenózní podání * MeSH
• kardiochirurgické výkony * škodlivé účinky   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• výsledek terapie MeSH
• záchvaty prevence a kontrola   etiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY Tranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss reduction in specific surgical procedures. The aim of our study was to evaluate the effect of tranexamic acid on reducing intraoperative blood loss, postoperative blood loss into the drain, total blood loss, transfusion requirements, and development of symptomatic wound hematoma in conventional single-level lumbar decompression and stabilization. MATERIAL AND METHODS The study included patients who had undergone a traditional open lumbar spine surgery in the form of single-level decompression and stabilisation. The patients were randomized into two groups. The study group received a 15 mg/kg dose of tranexamic acid intravenously during the induction of anaesthesia and then again 6 hours later. No tranexamic acid was administered to the control group. In all patients, intraoperative blood loss, postoperative blood loss into the drain, and therefore also total blood loss, transfusion requirements and potential development of a symptomatic postoperative wound hematoma requiring surgical evacuation were recorded. The data of the two groups were compared. RESULTS The cohort includes 162 patients, 81 in the study group and the same number in the control group. In the intraoperative blood loss assessment, no statistically significant difference between the two groups was observed; 430 (190-910) mL vs. 435 (200-900) mL. In case of post-operative drain blood loss, a statistically significantly lower volume was reported after the tranexamic acid administration; 405 (180-750) mL vs. 490 (210-820) mL. When evaluating the total blood loss, a statistically significant difference was also confirmed, namely in favour of the tranexamic acid; 860 (470-1410) mL vs. 910 (500- 1420) mL. The reduction of total blood loss did not result in a difference in the number of administered transfusions; transfusions were given to 4 patients in each group. A postoperative wound hematoma requiring surgical evacuation developed in 1 patient in the group with the tranexamic acid and in 4 patients in the control group, but the difference was not statistically significant with respect to the insufficient group size. No patient in our study experienced complications associated with tranexamic acid application. DISCUSSION The beneficial effect of tranexamic acid on reducing blood loss in lumbar spine surgeries has already been confirmed by numerous meta-analyses. The question remains in what types of procedures, at what dose and route of administration its effect is significant. To date, most of the studies have explored its effect in multi-level decompressions and stabilizations. Raksakietisak et al., for instance, report significant reduction in total blood loss from 900 (160, 4150) mL to 600 (200, 4750) mL following an intravenous injection of 2 bolus doses of 15 mg/kg tranexamic acid. In less extensive spinal surgeries, the effect of tranexamic acid may not be that distinct. In our study of single-level decompressions and stabilizations, no reduction in the actual intraoperative bleeding was confirmed at the given dosage. Its effect was seen only in the postoperative period in a significant reduction of blood loss into the drain, thus also in the total blood loss, although the difference between 910 (500, 1420) mL and 860 (470, 1410) mL was not that significant. CONCLUSIONS By intravenous application of tranexamic acid in 2 bolus doses in single-level decompression and stabilization of the lumbar spine a statistically significant reduction in postoperative blood loss into the drain and also total blood loss was confirmed. The reduction in the actual intraoperative blood loss was not statistically significant. No difference was observed in the number of administered transfusions. Following the tranexamic acid administration, a lower number of postoperative symptomatic wound hematomas was recorded, but the difference was not statistically significant. Key words: tranexamic acid, spinal surgeries, blood loss, postoperative hematoma.

• MeSH
• antifibrinolytika * MeSH
• hematom prevence a kontrola   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• pooperační krvácení prevence a kontrola   farmakoterapie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

• Klíčová slova
• lanadelumab,
• MeSH
• bolesti břicha etiologie   MeSH
• edém etiologie   farmakoterapie   MeSH
• hereditární angioedémy * diagnóza   farmakoterapie   MeSH
• humanizované monoklonální protilátky terapeutické užití   MeSH
• inhibiční protein komplementu C1 farmakologie   fyziologie   terapeutické užití   MeSH
• kyselina tranexamová farmakologie   terapeutické užití   MeSH
• lidé MeSH
• mladiství MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE OF THE STUDY To compare topical and intravenous (IV) administration of tranexamic acid (TXA) 2 g in patients undergoing total hip arthroplasty (THA), or total knee arthroplasty (TKA). MATERIAL AND METHODS In total, 452 patients undergoing THA or TKA were randomised to 3 groups: 1) the IV TXA group received 2 doses of TXA 1 g intravenously 3 hours apart; 2) the topical TXA group received TXA 2 g topically, and 3) the NO TXA - control group. Furthermore, each group was divided in two subgroups by performed surgery (THA versus TKA). The following endpoints were used for final analysis: postoperative blood loss, transfusion requirement, haemoglobin drop and postoperative complications (haematoma, surgical site infection, thromboembolism, early surgical revision). RESULTS Both topical and IV administration of TXA significantly reduced postoperative bleeding (mean ± standard deviation) after THA and TKA (topical 504.4±281.0 ml, IV 497.3±251.7 ml, NO 863.1±326.4 ml, p<0.001). Topical use was superior to IV in reducing postoperative drainage output in THA (topical 377±213.3 ml, IV 518.1±259.0 ml, p<0.01). On the opposite, IV use was superior to topical in drainage output in TKA (topical 646.1±281.3 ml, IV 457.8±235.8 ml, p<0.01). The differences in transfusion requirement and Hb drop between these administration methods were not statistically significant (p≥0.05), but any TXA administration was significantly better than no TXA in all endpoints of efficacy (p<0.001). The lowest complication rate was observed in the topical group (NO 24%, IV 19%, topical 7.5%). DISCUSSION Consensus on optimal TXA dosing regime in primary hip and knee arthroplasties is still missing. Use of TXA therapy in routine clinical practice is highly individualized in accordance with the current approach of personalized medicine. Topical application seems to be the safest route of TXA administration. However, precise application technique is essential. IV TXA is beneficial especially in patients with some bleeding coagulopathies undergoing TKA with a tourniquet. Repeat doses of TXA are not usually necessary after completed primary arthroplasties. CONCLUSIONS IV and topical TXA 2 g have similar effect on reduction of transfusion requirements and haemoglobin drop in THA and TKA. The IV route is superior to topical in TKA while topical TXA reduces complications in both THA and TKA. Key words: tranexamic acid, total hip arthroplasty, total knee arthroplasty, topical administration, intravenous administration.

• MeSH
• antifibrinolytika * MeSH
• aplikace lokální MeSH
• hemoglobiny MeSH
• intravenózní podání MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   metody   MeSH
• totální endoprotéza kolene * škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

AIM: To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). MATERIAL AND METHOD: We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. RESULTS: The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011). CONCLUSION: In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.

• MeSH
• antifibrinolytika * MeSH
• aplikace lokální MeSH
• intravenózní podání MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• totální endoprotéza kolene * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH