BACKGROUND: The optimal radiotherapy technique for cardiac sparing in left-sided early breast cancer (EBC) is not clear. In this context, the aim of our dosimetric study was to compare cardiac and lung doses according to the type of radiotherapy - whole breast irradiation (WBI), external partial breast irradiation (PBI), and multicatheter interstitial brachytherapy-accelerated partial breast irradiation (MIB-APBI). The dosimetric results with the WBI and PBI were calculated with and without DIBH. MATERIALS AND METHODS: Dosimetric study of 23 patients treated with WBI, PBI, with and without DIBH, or MIB-APBI. The prescribed dose was 40 Gy in 15 fractions for WBI and PBI and 34 Gy in 10 fractions (bid) for MIB-APBI. Doses to the organs-at-risk (OAR) - heart, left anterior descending coronary artery (LAD), left ventricle (LV), and left lung - were recalculated to the equivalent dose in 2-Gy fractions (EQD2). RESULTS: The addition of DIBH significantly reduced EQD2 doses to all OARs (except for the left lung maximal dose) in WBI and PBI. MHD values were 0.72 Gy for DIBH-WBI, 1.01 Gy for MIB-APBI and 0.24 Gy for DIBH-PBI. There were no significant differences in cardiac doses between WBI with DIBH and PBI without DIBH. DIBH-PBI resulted in significantly lower mean doses to all OARs (except for maximum lung dose) compared to MIB-APBI. Conclusions: These results show that the use of DIBH significantly reduces cardiac doses in patients with left EBC. Partial irradiation techniques (PBI, MIB-APBI) significantly reduced cardiac doses due to the smaller clinical target volume. The best results were obtained with DIBH-PBI.
- Publikační typ
- časopisecké články MeSH
Background: Although several prognostic factors for survival have been identified in glioblastoma, there are numerous other potential markers (such as hemoglobin) whose role has not yet been confirmed. The aim of this study was to evaluate a wide range of potential prognostic factors, including HIF-1α and hemoglobin levels, for survival in glioblastoma. A secondary aim was to determine whether hemoglobin levels were associated with HIF-1α expression. Methods: A retrospective study of 136 patients treated for glioblastoma at our institution between 2012 and 2021 was performed. Cox univariate and multivariate analyses were carried out. Kaplan-Meier survival curves were generated. In addition, bivariate non-parametric correlation analyses were performed for key variables. Results: Median survival was 11.9 months (range: 0-119.4). According to the univariate analysis, 13 variables were significantly associated with survival: age, performance status, extent of surgery, tumor depth, tumor size, epilepsy, postoperative chemoradiotherapy, IDH mutations, CD44, HIF-1α, HIF-1β, vimentin, and PDFGR. According to the multivariate regression analysis, only four variables remained significantly associated with survival: age, extent of surgery, epilepsy, and HIF-1α expression. No significant association was observed between hemoglobin levels (low <120 g/L in females or <140 g/L in males vs. high ≥120 or ≥140 g/L) and survival or HIF-1α/HIF-1β expression. Conclusions: In this retrospective study of patients with glioblastoma, four variables-age, extent of surgery, HIF-1α expression, and epilepsy-were significant prognostic factors for survival. Hemoglobin levels were not significantly associated with survival or HIF-1α expression. Although hypoxia is a well-recognized component of the glioblastoma microenvironment, more research is needed to understand the pathogenesis of onset tumor hypoxia and treatment implication.
- Publikační typ
- časopisecké články MeSH
Nádory endometria jsou onemocněním se stále vzrůstající incidencí, v současné době jsou celosvětově šestým nejčastějším nádorovým onemocněním u žen. Zahrnují několik histologických subtypů s různou prognózou. V současnosti nabývá na důležitosti molekulární klasifikace nádoru, která může významně ovlivnit plánovaný léčebný postup a vede k možnosti využití přesně cílené individualizované léčby pro každou pacientku.
Endometrial tumours (EC) are a disease with an increasing incidence. Currently they are the sixth most common cancer in women worldwide. EC include several histological subtypes with different prognoses. Currently, the molecular classification of the tumour is gaining importance, which can significantly influence the planned treatment procedure and leads to the possibility of using precisely targeted individualized treatment for each patient.
- MeSH
- adjuvantní chemoterapie metody MeSH
- imunoterapie MeSH
- lidé MeSH
- nádory endometria * diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Zhoubné nádory těla děložního jsou nejčastější gynekologickou malignitou vyspělých zemí. V pokročilém stadiu je diagnostikováno přibližně 10-15 % pacientek. Léčba metastatického karcinomu endometria v posledních letech pokročila, za což vděčíme také velmi pestrému molekulárnímu profilu nádorového onemocnění. Kromě chirurgického řešení a radioterapie jsou k dispozici nejen cytotoxická chemoterapie, ale také imunoterapie, hormonální terapie a cílená léčba. Článek je přehledem současně používané léčby tohoto onemocnění v ČR.
Malignant tumors of the uterine body are the most common gynecological malignancy in developed countries. In advanced stages, approximately 10-15 % of patients are diagnosed. The treatment of metastatic endometrial carcinoma has advanced in recent years, thanks in part to the diverse molecular profile of the disease. In addition to surgical and radiotherapeutic approaches, not only cytotoxic chemotherapy but also immunotherapy, hormonal therapy, and targeted treatment are available. This article provides an overview of the currently used treatments for this condition in the Czech Republic.
- MeSH
- antitumorózní látky hormonální farmakologie terapeutické užití MeSH
- imunoterapie MeSH
- lidé MeSH
- metastázy nádorů MeSH
- nádory endometria * terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS: Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2‑Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS: Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION: Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.
- MeSH
- brachyterapie metody MeSH
- celková dávka radioterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu radioterapie MeSH
- prsy účinky záření MeSH
- retrospektivní studie MeSH
- srdce účinky záření MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Introduction: Pulsed field ablation (PFA) exploits the delivery of short high-voltage shocks to induce cells death via irreversible electroporation. The therapy offers a potential paradigm shift for catheter ablation of cardiac arrhythmia. We designed an AC-burst generator and therapeutic strategy, based on the existing knowledge between efficacy and safety among different pulses. We performed a proof-of-concept chronic animal trial to test the feasibility and safety of our method and technology. Methods: We employed 6 female swine - weight 53.75 ± 4.77 kg - in this study. With fluoroscopic and electroanatomical mapping assistance, we performed ECG-gated AC-PFA in the following settings: in the left atrium with a decapolar loop catheter with electrodes connected in bipolar fashion; across the interventricular septum applying energy between the distal electrodes of two tip catheters. After procedure and 4-week follow-up, the animals were euthanized, and the hearts were inspected for tissue changes and characterized. We perform finite element method simulation of our AC-PFA scenarios to corroborate our method and better interpret our findings. Results: We applied square, 50% duty cycle, AC bursts of 100 μs duration, 100 kHz internal frequency, 900 V for 60 pulses in the atrium and 1500 V for 120 pulses in the septum. The inter-burst interval was determined by the native heart rhythm - 69 ± 9 bpm. Acute changes in the atrial and ventricular electrograms were immediately visible at the sites of AC-PFA - signals were elongated and reduced in amplitude (p < 0.0001) and tissue impedance dropped (p = 0.011). No adverse event (e.g., esophageal temperature rises or gas bubble streams) was observed - while twitching was avoided by addition of electrosurgical return electrodes. The implemented numerical simulations confirmed the non-thermal nature of our AC-PFA and provided specific information on the estimated treated area and need of pulse trains. The postmortem chest inspection showed no peripheral damage, but epicardial and endocardial discolorations at sites of ablation. T1-weighted scans revealed specific tissue changes in atria and ventricles, confirmed to be fibrotic scars via trichrome staining. We found isolated, transmural and continuous scars. A surviving cardiomyocyte core was visible in basal ventricular lesions. Conclusion: We proved that our method and technology of AC-PFA is feasible and safe for atrial and ventricular myocardial ablation, supporting their systematic investigation into effectiveness evaluation for the treatment of cardiac arrhythmia. Further optimization, with energy titration or longer follow-up, is required for a robust atrial and ventricular AC-PFA.
- Publikační typ
- časopisecké články MeSH
Obezita je multifaktoriálně podmíněná metabolická porucha, u které je nutné brát v úvahu individuální geneticky podmíněnou náchylnost k hromadění tukových zásob při pozitivní energetické bilanci. Pokud by však tato definice vystihovala problematiku obezity plně, pak by k terapii obezity postačovala pouze somaticky orientovaná medicína. A přestože tomu tak často je, musíme obezitu pojímat komplexněji. Nejedná se jen o poruchu týkající se nevhodného složení těla, obézní mají též odlišné psychické nastavení. Nelze léčit jen somatickou poruchu, nevhodné stravovací a pohybové návyky, je podstatné zaměřit se též na kognice a emoce, které k takovému nevhodnému chování vedou. Celkově lze shrnout, že chování, myšlení a emoce lze předvídat, usměrňovat a kontrolovat systematickým ovlivňováním podnětů spouštějících nevhodné chování. Cílem psychologické intervence nejsou pouhé hmotnostní úbytky, ale lepší pocit ze sebe sama, zvýšení sebevědomí, utužení tělesné i psychické kondice, tedy zlepšení kvality života, kdy se nové chování posiluje a udrží dlouhodobě. V psychoterapii lze použít různé přístupy, nejužívanější jsou kognitivně-behaviorální terapie, existenciální analýza a v posledních letech také přístupy psychodynamické. Role psychologa je důležitá jak při konzervativní léčbě obezity, tak také v případě metabolicko-bariatrického řešení. Výzkumy ukazují, že z osobnostních rysů u pacientů s obezitou dominuje hlavně neuroticismus, který zahrnuje úzkostnost, depresivitu, impulzivitu, hněv a hostilitu. Obezitou ve vysoké míře trpí i děti a dospívající. V terapii dětské nadváhy a obezity je podobně jako u dospělých zásadní aktivní změna nevhodných stravovacích a pohybových návyků. V tomto procesu hraje významnou roli především rodina dítěte a motivace obézního potomka danou změnu učinit. Je však nutné podotknout, že kromě snahy o úpravu životního stylu tvoří součást psychoterapie této skupiny dětských a dospívajících pacientů také řešení psychických potíží, jež nadváhu a obezitu doprovázejí.
Obesity is a metabolic disorder conditioned by several factors with the individual genetic proneness to accumulation of body fat with a positive energetic balance. If such definition describes the essential nature of obesity aptly, the treatment thereof ought to be the realm of somatic medicine and somatically oriented physicians, which is, unfortunately, frequently the case. Yet, not only being a disorder concerning improper body composition, but also a difference in cognitive processes and emotions of the obese, obesity needs to be considered in a more complex manner. The life of the obese consists of periods of strict, starvation diets on one hand and total loss of control and excessive calorie intake. Therefore, the corresponding therapy also needs to be provided in a more complex fashion, i.e. it is not solely the somatic disorder that should be addressed, but also the emotions and cognitions which induce the undesirable behaviour. Generally, it is possible to summarise that cognition and emotions are likely to be anticipated, directed and controlled by affecting the stimuli promoting the erratic attitude. Thanks to the achievements which relate not only to loss of weight, but also to higher self-esteem, more gratifying feelings aroused by the patient’s self, improvement of both physical and mental conditions and enhancement of the quality of life as a whole, the new behaviour patterns are established, strengthened and sustained on a long-term basis. Several psycho-therapeutic attitudes/methods may be used with cognitive-behavioral therapy, existential therapy and, recently, psychodynamic approach. The psychologist’s role is essential and fundamental in both conservative and the metabolic-bariatric treatment of obesity. The most common character traits of obese patients include predominantly neuroticism, which comprises anxiety, depressions, impulsiveness, anger and hostility.Likewise, obesity is often suffered from by children and adolescents and its treatment relies on, in like manner as with adults, an active change of unsuitable dietary and movement habits with the family of the patient and their motivation of the patient to make the desirable change. It needs to be noted, however, that except for the changes in lifestyle, treatment of psychological difficulties accompanying obesity is a part of psychotherapy of such a group of young and adolescent patients.
Východiska: Chemoterapie (CHT) je důležitou modalitou využívanou v léčbě nádorových onemocnění. V užším smyslu se pod pojmem chemoterapie rozumí léčba cytostatiky. Tato léčba je spojena s množstvím nežádoucích účinků (NÚ), které jsme v současnosti více či méně schopni ovlivňovat a předcházet jim. Mezi nejčastější NÚ patří únava, nauzea a zvracení, vypadávání vlasů, průjem a zácpa, změny v krevním obrazu jako anémie, neutropenie, trombocytopenie a s tím související infekce, horečka nebo krvácení. Mnoho vedlejších účinků chemoterapie se vyskytuje u pacientů jeden až několik dní po podání chemoterapie, pacienti jsou často již v domácím prostředí. Pacienti a jejich rodiny by měli být informováni o tom, jaké vedlejší účinky je u jednotlivých druhů chemoterapie možné očekávat a měli by mít základní informace o způsobu možnosti zvládání těchto nežádoucích obtíží. Velmi důležitá je také pro pacienta informace o tom, v jakých případech je vhodnější vyhledat lékařskou péči a kam se obrátit pro pomoc, když si není jistý, jak vzniklý zdravotní problém řešit. Proto je potřeba pacienty seznamovat s možnými nežádoucími účinky a možností jejich terapie a prevence už v ambulanci před podáním samotné chemoterapie.
Background: Chemotherapy is an important modality used in treating cancer diseases. Strictly speaking, the term chemotherapy refers to treatment with cytostatic drugs. This treatment is associated with a number of adverse effects that, more or less, can currently be managed and prevented. The most common adverse effects include fatigue, nausea and vomiting, hair loss, diarrhoea and constipation, blood count alterations such as anaemia, neutropenia, thrombocytopenia and associated infections, fever, or bleeding. Many side effects of chemotherapy occur in patients within one or several days of chemotherapy administration, after patients have returned home. Patients and their families should be informed on what side effects can be expected with particular types of chemotherapy, and should obtain basic information on how to manage these adverse effects. Of major importance for patients is the information on when they should seek medical attention and where to turn for help when not certain how to manage a health problem that has occurred. Therefore, it is necessary to acquaint patients with possible adverse effects and the ways of treating and preventing them already in the office prior to chemotherapy administration. Purpose: The review article discusses chemotherapy adverse effects, their management and possible prophylaxis. Conclusion: Nowadays, not only the treatment of cancer disease itself, but also the quality of life of the patient treated for the disease are both very important. Hence, adequate attention has to be paid to adverse effects that may occur as a result of treatment, as well as to the use of prophylaxis that is an equally important part of patient care.
- Klíčová slova
- myelosuprese,
- MeSH
- anemie chemicky indukované etiologie farmakoterapie MeSH
- faktor stimulující kolonie granulocytů terapeutické užití MeSH
- febrilní neutropenie vyvolaná chemoterapií diagnóza prevence a kontrola MeSH
- filgrastim terapeutické užití MeSH
- kožní manifestace MeSH
- lidé MeSH
- nádory farmakoterapie MeSH
- nauzea chemicky indukované farmakoterapie prevence a kontrola MeSH
- nemoci nehtů chemicky indukované prevence a kontrola MeSH
- neurotoxické syndromy etiologie prevence a kontrola MeSH
- nežádoucí účinky léčiv farmakoterapie klasifikace prevence a kontrola terapie MeSH
- průjem chemicky indukované etiologie prevence a kontrola terapie MeSH
- zácpa chemicky indukované prevence a kontrola terapie MeSH
- zvracení chemicky indukované farmakoterapie klasifikace prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
For the first time, the combination of molecularly imprinted polymer (MIP) technology with laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) is presented with focus on an optimization of the LA-ICP-MS parameters such as laser beam diameter, laser beam fluence, and scan speed using CdS quantum dots (QDs) as a template and dopamine as a functional monomer. A non-covalent imprinting approach was employed in this study due to the simplicity of preparation. Simple oxidative polymerization of the dopamine that creates the self-assembly monolayer seems to be an ideal choice. The QDs prepared by UV light irradiation synthesis were stabilized by using mercaptosuccinic acid. Formation of a complex of QD-antibody and QD-antibody-antigen was verified by using capillary electrophoresis with laser-induced fluorescence detection. QDs and antibody were connected together via an affinity peptide linker. LA-ICP-MS was employed as a proof-of-concept for detection method of two types of immunoassay: 1) antigen extracted from the sample by MIP and subsequently overlaid/immunoreacted by QD-labelled antibodies, 2) complex of antigen, antibody, and QD formed in the sample and subsequently extracted by MIP. The first approach provided higher sensitivity (MIP/NIP), however, the second demonstrated higher selectivity. A mixture of proteins with size in range 10-250 kDa was used as a model sample to demonstrate the capability of both approaches for detection of IgG in a complex sample.
- MeSH
- elektroforéza kapilární MeSH
- fluorescence MeSH
- hmotnostní spektrometrie * MeSH
- imunoanalýza metody MeSH
- imunoglobulin G analýza MeSH
- kvantové tečky chemie MeSH
- laserová terapie * MeSH
- molekulový imprinting * MeSH
- myši MeSH
- počítačové zpracování signálu MeSH
- polymery chemie MeSH
- proteiny analýza MeSH
- sloučeniny kadmia chemie MeSH
- sulfidy chemie MeSH
- zvířata MeSH
- Check Tag
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
