Fulltext search in archive

The article describes a single centre experience using the minimally invasive extracorporeal (MiECC) circulation that was modified by incorporation of coronary suction into the circuit, while maintaining the core principles of closed circuit perfusion. A detailed description of the construction of the circuit is provided. Perfusion management and the specific demands placed on the surgeon are explained in the article. The results of the retrospective analysis of clinical outcomes after utilization of this circuit in comparison to the conventional extracorporeal circulation are presented and discussed. The study focused mainly on major adverse events and blood loss comparison. The results demonstrate lower post-operative blood loss in patients operated on the MiECC circuit.

This work provides an in-depth exploration of mitochondrial functions beyond energy production, highlighting their essential roles in cellular processes, signaling, and health maintenance. By emphasizing recent advances in mitochondrial research, the manuscript underscores the impact of mitochondria in aging, disease, and exercise, offering valuable insights that could guide therapeutic strategies for enhancing mitochondrial health and longevity

Objective. To evaluate transperitoneal laparoscopic adrenalectomies performed at the University Hospital, Olomouc over a period of 20 years. Introduction. Thanks to the increased availability of imaging, the detection of adrenal disease is increasing. Laparoscopic adrenalectomy is now regarded as the gold standard for the treatment of adrenal disease due to its safety and efficacy despite the increasing popularity of robotic-assisted surgery. Methods. Over a period of 20 years, from 2002 to 2021, we retrospectively evaluated a cohort of 405 patients who had undergone laparoscopic adrenalectomy. The indication criteria for laparoscopic adrenalectomy were hormonally active symptomatic tumours (pheochromocytoma, Conn's syndrome, Cushing's syndrome, etc.), symptomatic cysts or myelolipomas, carcinomas, metastatic disabling or incidentalomas, growing at a rate >1 cm or more per year. Data collected focused on sex, age, medical classification, imaging, operative time, side dominance, hormonal activity, complications associated with surgery, length of hospital stay, and histopathologic verification. No patient who had undergone laparoscopic adrenalectomy was excluded from the cohort. Patients in our cohort were not operated by a single surgeon. Results. Women accounted for 52.1% (211) and men 47.9% (194). The mean age was 55.6 years, BMI 28.7, and median ASA score was 2. Preoperative imaging included abdominal CT in 352 (86.9%) patients, abdominal MRI with contrast agent in 8 (2.0%), and PET/CT in 45 (11.1%) patients. More frequent findings were on the right side in 223 (54.39%) patients. Hormonal activity was found in 271 patients (67 %). Hormone overproduction from the right adrenal gland was found in 120 (44.3%) patients, and from the left in 151 (55.7%). Adenoma was the most frequent histological finding, followed by hyperplasia. Conversion to open surgery was due to bleeding in 2 patients. There was no perioperative or postoperative mortality. According to the Clavien-Dindo classification, minor complications (Grade I) occurred in 375 patients (92.6%). Grade II complications were reported in 17 patients (4.2%). Grade III complications were identified in 13 patients (3.2%) due to operative field bleeding; in three cases (0.7%), surgical revision of the adrenalectomy bed was required. Conclusion. Laparoscopic adrenalectomy is a safe surgical method for the management of adrenal disease and our retrospective follow-up confirmed that it remains the gold standard.

The Measles-Rubella-Zoster (MRZ) reaction is a test for the intrathecal synthesis of IgG antibodies against measles, rubella and varicella zoster viruses. Since the 1990s, it has been used as an adjunctive test to support the diagnosis of multiple sclerosis (MS), although it has no formal role in current McDonald diagnostic criteria and its clinical relevance remains debated. While early studies considered a single elevated antibody index (M, R or Z) as a positive result, the practice today requires at least two elevated antibody indices (M+R, M+Z, or R+Z), referred to as a polyspecific MRZ reaction (MRZ-2). MRZ-2 is the most specific laboratory marker for MS, with reported specificity exceeding 90%. However, sensitivity varies widely across studies, ranging from approximately 30% to over 70%. In the Czech adult MS population, MRZ-2 sensitivity was recently reported at 32%, markedly lower than the 67% pooled sensitivity reported in a meta-analysis of predominantly German cohorts. Broadening the panel of anti-viral antibodies (MRZ+) has been proposed to improve sensitivity, with parvovirus B19 and mumps virus being the most promising candidates. Further studies are required to determine whether an extended panel can increase sensitivity while maintaining high diagnostic specificity.

Heart failure (HF) remains a growing public health concern. This study provides an updated analysis of HF incidence, prevalence, hospitalizations, and mortality trends in the Czech Republic (2015-2023). Using data from the National Healthcare Reimbursement Database (NRHZS), the authors evaluated key epidemiological patterns. Findings show a rising prevalence, stable incidence, and a slight decline in hospitalizations, while in-hospital mortality remains around 10%. Increased use of novel HF therapies, including ARNIs and SGLT2 inhibitors, was observed. These insights highlight the need for improved guideline adherence and multidisciplinary care models.

Congenital hypofibrinogenemia (CH) and congenital dysfibrinogenemia (CD) are rare coagulation disorders caused by quantitative or qualitative defects in the fibrinogen gene. In this study, the authors, working to identify genetic variants and expanding knowledge about genetic variants in Slovak patients with congenital fibrinogen disorders registered at the National Haemophilia Centre. Molecular-genetic analysis have revealed six novel variants in 36 patients - FGA c.923_968dup p.(Gly324Lysfs*44) and FGG c.1105C>T p.(His369Tyr) were identified in CD patients. In CH patients, in the FGG gene c.8G>A p.(Trp3*), c.823G>T p.(Glu275*) and c.323C>A p.(Ala108Asp) variants were detected. In the FGB gene c.1427C>T p.(Ser476Leu) was identified.

Acute cellular rejection (ACR) is a common issue after lung transplantation, but standardized screening remains elusive. This study compared histological transbronchial biopsy assessment with donor-derived cell-free DNA (dd-cfDNA) as a biomarker for detecting ACR. 74 samples obtained from lung transplant recipients were analysed, with ACR cases defined by histological grade and/or treatment necessity (n=10, 14%). Results showed significantly higher dd-cfDNA in ACR cases (61.2 cp/mL vs. 25.8 cp/mL in controls; P=0.04), but dd-cfDNA% and total cfDNA were not significantly different. While dd-cfDNA may help rule out ACR, further research is needed to refine its clinical application.

DNA methylation plays a critical role in the regulation of gene expression in the human leukocyte antigen (HLA) system which is a key component of immune function. This article reviews the molecular mechanisms by which DNA methylation influences HLA gene regulation, highlighting its impact on their antigen presentation and immune tolerance functions. We describe how methylation patterns vary in HLA class I and II genes, affecting their expression in a tissue- and allele-specific manner. In addition, we examine the interplay of DNA methylation in shaping immune responses. A focus is on the role of methylation in immune-mediated, namely autoimmune diseases, where aberrant epigenetic modifications at HLA loci contribute to disease susceptibility and progression. We also explore how single nucleotide polymorphisms (SNPs) within CpG sites can alter methylation patterns and gene expression, providing insights into genetic-epigenetic interactions. These findings may contribute to the development of new diagnostic and therapeutic strategies for immune-mediated diseases.

This study aimed to investigate changes in fundus autofluorescence in patients taking daily lutein oral supplements and to develop image processing methods for follow-up evaluations of the images. Dual wavelength fundus autofluorescence is a valuable technique for macular pigment evaluation in follow-up examinations, utilizing software image post-processing with commonly available hardware.

Background. Proinflammatory cytokines are a pivotal factor in cancer initiation and progression. The paracrine and autocrine secretions of such inflammatory cytokines are reported in different cancer types. Recently, C-C motif ligand (CCL) 5 (CCL5), CCL22, granulocyte-colony stimulating factor (G-CSF), and interleukin-1 receptor antagonist (IL-1 RA) have been detected in basal secretions of breast cancer (BC) cells and linked to BC pathogenesis. While Vitamin D has been found to have anti-inflammatory effects, its modulation on cytokine expression is rarely studied in relation to cancer. Aims. In this study, we evaluated whether vitamin D could modulate cytokine basal levels in BC. Materials and Methods. This in vitro study was conducted on BC cell lines, MCF-7 and MDA-MB-231. Cells were treated with vitamin D (10 and 100 nM), and cytokine levels were measured using the Enzyme-Linked Immunosorbent Assay (ELISA). Results. There was a significant reduction in CCL5 total levels in MCF-7 cells at both concentrations (P≤0.01) and in MDA-MB-231 at 100 nM (P≤0.05). Both concentrations reduced CCL22 levels significantly in MCF-7 (P≤0.05) and MDA-MB-231 (P≤0.01). Regarding G-CSF, a significant reduction was found in MCF-7 at both concentrations (P≤0.05) and at 100 nM in MDA-MB-231 (P≤0.01). In comparison, IL-1 RA levels were significantly elevated in MCF-7 (100 nM (P≤0.01)) and MDA-MB-231 (10 nM (P≤0.05) and 100 nM (P≤0.01)). Conclusion. Vitamin D down-regulated the pro-inflammatory and up-regulated the anti-inflammatory cytokines. This indicates that vitamin D can modulate the expression of inflammatory mediators, particularly in a cancer setting. The results support the potential use of vitamin D as an anti-cancer agent with anti-inflammatory properties.

Introduction. Intraoperative neurophysiological monitoring is a standard in surgeries with an increased risk of iatrogenic neurological injury development. The gold standard for this monitoring modality is propofol-based total intravenous anaesthesia (TIVA). Although there seems to be no clinically significant complication for propofol administration in patients with soy, egg, or peanut allergies, a whole range of recommendations still prohibit propofol administration in patients with these allergies. Remimazolam is a new, ultra-short-acting benzodiazepine that can potentially be an alternative in cases of propofol contraindications in need of TIVA. Case reports. We report two cases of a 19-year-old girl and a 17-year-old boy undergoing scoliosis surgery with transcranial motor evoked potentials monitoring (TcMEP). We chose remimazolam-based total intravenous anaesthesia due to the severe peanut and soy allergy, respectively. Total intravenous anaesthesia was maintained with remimazolam at a dose of 1.5-2 mg/kg/h and remifentanil at a dose of 0.5-0.8 µg/kg/min. Depth of anaesthesia was controlled using frontal EEG monitoring. TcMEP remained stable and showed no significant alterations throughout the surgeries. No new neurological deficits were detected after the surgeries. Conclusion. Our results show that remimazolam-based anaesthesia may be a safe alternative to propofol-based anaesthesia for surgeries with an intraoperative neurophysiological monitoring, or patients with propofol contraindications but more data are needed.

Cervical cancer remains a major contributor to cancer-related mortality among women worldwide, despite substantial progress in prevention and treatment strategies. While established prognostic factors such as tumor size, lymphovascular space invasion, and nodal status guide clinical decision-making, they lack sufficient specificity for individualized risk stratification. Consequently, there remains an unmet need for robust biomarkers capable of reliably predicting recurrence and treatment response. L1 cell adhesion molecule (L1CAM), a neural adhesion protein implicated in epithelial-mesenchymal transition (EMT), tumor invasion, and metastasis, has emerged as a candidate prognostic marker in several solid tumors, including gynecologic malignancies. Its role in cervical cancer, however, remains insufficiently defined. This narrative review synthesizes preclinical evidence and clinical studies evaluating L1CAM expression in cervical cancer, with an emphasis on its biological rationale, methodological challenges, and prognostic significance across different disease contexts. Data from early-stage and from locally advanced disease were critically appraised. Most early-stage studies have not demonstrated an independent prognostic effect of L1CAM, although associations with adverse histopathological features have been reported. In contrast, recent multicenter evidence suggests that high-level L1CAM expression (≥50%) may predict inferior pelvic control in patients undergoing chemoradiotherapy, underscoring a potential context-dependent prognostic role. Current evidence emphasizes the need for standardized immunohistochemistry protocols, prespecified positivity thresholds, and integration of L1CAM assessment with other. Prospective, adequately powered studies are essential to validate L1CAM as a clinically actionable biomarker and to determine whether its incorporation into prognostic models can enhance treatment personalization in cervical cancer.

Patients with atrial fibrillation (AF) may experience other supraventricular tachycardias (SVT) that can trigger AF and cause similar symptoms. This study aimed to analyse the safety and efficacy of inducing SVT in patients undergoing catheter ablation (CA) for AF. The authors enrolled 61 patients with paroxysmal AF who underwent CA between January 2022 and March 2023. This electrophysiological study was performed after pulmonary vein isolation (PVI) to induce SVT. Induced arrhythmias were mapped and ablated. All patients were followed at 3, 6 and 12 months after the procedure and seven-day ECG Holter monitoring was carried out after 6 and 12 months from the procedure. SVT inducibility after successful pulmonary vein isolation was 39%. Age differed significantly in patients with arrhythmia inducibility compared to those without (64.5± 7.6 and 58.2±10.5, P=0.04). There were no significant differences in procedure time (P=0.408) or fluoroscopy dose (P=0.458) between patients with inducible arrhythmia and those without. None of the echocardiographic parameters showed any significant differences between groups. The conclusion of the study is that ablation of induced non-clinical arrhythmia is safe and does not prolong the total procedure or fluoroscopy time.

Introduction. Ovarian tumours represent a highly malignant disease that is often diagnosed at an advanced stage and is associated with a poor prognosis. The most common histological type is high-grade serous carcinoma, characterized by significant genomic instability and homologous recombination defects, particularly due to pathogenic variants in the BRCA1 and BRCA2 genes. The introduction of high throughput sequencing methods has enabled the identification of a broader spectrum of predisposing genes and further emphasised the importance of genetic testing for targeted prevention and individualised treatment. Methods. The aim of our study was to determine the frequency of germline mutations in 117 unrelated patients diagnosed with ovarian, tubal, or primary peritoneal cancer. We also assessed epidemiological and tumor pathogenesis data. The patients were examined with the "CZECANCA" gene panel sequenced by next-generation sequencing (NGS) on an Illumina platform. Results. Pathogenic variants were found in 29% of patients, most commonly mutations in the BRCA1 and BRCA2 genes. The median age of patients with high-grade serous ovarian cancer was 61 years. The median age of BRCA1/2-positive women was 54 years, and all had a positive family history of cancer. Conclusion. Identifying carriers of pathogenic variants enables targeted prevention, earlier detection, and personalized therapy. Despite significant advances in treatment, early diagnosis and screening of at-risk individuals remain a major challenge.

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological disorder with a significant impact on quality-of-life. The administration of cannabidiol/hyaluronic acid based suppositories demonstrated potential symptom relief in CP/CPPS with a favourable tolerability profile.

Percutaneous transthoracic needle biopsy of lung lesions is an alternative to bronchoscopic confirmation of lung lesions. The aim of this study was to assess the risk of pleural recurrence for all types of lung lesions. To the best of their knowledge, this has so far only been investigated in stage I lung tumors and not in all lung lesions. Secondary objectives included assessment of diagnostic yield and safety with respect to the incidence of pneumothorax and hemorrhage. In this study, percutaneous transthoracic needle biopsy of lung lesions showed high sensitivity and low degree of acute complications requiring an invasive solution. The risk of pleural recurrence after a biopsy was very low.

Six multiple sclerosis (MS) patients with a rapid progression of disability underwent immunoablative therapy followed by autologous hematopoietic stem cell transplantation (AHSCT) as the first-line disease-modifying therapy, between 2018 and 2021. Four out of six patients showed disability progression after AHSCT, so the rapid progression of MS was just slowed down by AHSCT. One patient developed activity on magnetic resonance imaging and two patients experienced mild relapses after AHSCT. None of the patients developed grade 4 non-hematological toxicity.

The authors confirmed Johanson-Blizzard syndrome in a Czech proband by identification and characterization of two novel causal variants in the UBR1 gene (NM_174916.3), c.3482A>C and c.3509+6T>C. Using RNA and in silico analysis, they revealed that the splice site variant c.3509+6T>C induced the removal of a very rare non-canonical GC-AG intron and that the missense variant c.3482A>C altered a highly conserved zinc-coordinating histidine in the zinc-stabilized domain RING-H2. Although the variants were found in trans, neither was detected in the parents. To the best of their knowledge, the authors report the first molecular confirmation of JBS in the Czech Republic and the first identification of two de novo causal variants in two alleles.

This narrative review offers a unique perspective on recent advances in the genetics, diagnosis, and management of neurofibromatosis type 1. Unlike previous studies, it incorporates the updated 2021 NIH criteria, emphasizing the role of genetic testing for early diagnosis and personalized treatment. The article highlights genotype-phenotype correlations, the impact of specific mutations on disease severity, and the need for continuous monitoring. It also covers less commonly addressed aspects, such as the increased breast cancer risk in women with NF1, emerging therapies like MEK inhibitors, and the importance of tailored surveillance, making it a valuable contribution to NF1 management.

The correct position of the intraocular lens and its stability in the capsular bag is crucial for the quality of the retinal image after cataract or refractive surgery. Although some tilt and decentration of the intraocular lens are common, greater extent of the tilt and decentration cause optical aberrations which have a negative impact on patients' visual comfort. The purpose of the article was to describe a new dynamic Purkinje-meter, an experimental method for intraocular lens position measurement based on the analysis of Purkinje images which could have a wider use than the existing static Purkinje-meters. The method was verified on a group of pseudophakic eyes: the values of decentration and tilt measured on the dynamic Purkinje-meter were comparable to those from commercially available anterior segment optical coherence tomography CASIA2.

This article addresses the issue of chromosomal testing in patients with uveal melanoma. It is currently the only examination that can predict the development of metastases in patients with malignant uveal melanoma. The significance of chromosome 3 testing is unequivocal. This article deals with the testing of chromosomes 6 and 8 and their importance in predicting metastatic involvement. In a retrospective study, a cohort of 54 patients underwent testing of melanoma chromosome 6 and 8 from enucleated eyes. The authors demonstrated the importance of chromosome 8 abnormalities in patients without monosomy 3. The gain of chromosome 8, in fact, overturns the favourable prognosis of disomy 3. Currently, for the first time in the history of ophthalmology, a drug has been approved that extends survival in metastatic uveal melanoma. Chromosomal testing in samples of malignant melanoma is gaining significance.

The study aimed to determine the preoperative clinical and molecular genetic risks of malignancy in indeterminate nodules (Bethesda III and IV) and their influence on the surgical treatment strategy of hemi/total thyroidectomy. Molecular tests were focused on the occurrence of pathogenic variants of somatic genes BRAF, RAS, TERT and rearrangements of RET/PTC, PAX8/PPARγ associated with thyroid oncogenesis. The incidence of clinical risk factors for malignancy was evaluated. The presence of at least one of these led to a significantly higher incidence of malignancy than in cases of their absence. From the experience of the authors so far, molecular genetic testing is one of the many decision-making factors in elective surgical procedures.

The possibility of using deep-frozen corneal stromal lenticules could significantly help in the treatment of corneal ulcers or even perforations, which is currently difficult due to the relative unavailability of corneal tissue donors, especially in developing countries.

Heart failure is one of the critical and most costly medical challenges of the 21st century. It is a chronic debilitating condition and adherence to medication, a precondition for successful treatment is often poor. There are various interventions for improving adherence. Depending on the goal of the intervention, these are roughly patient centric, healthcare provider centric and system centric. The authors provide an overview of these interventions with a focus on effectiveness and appropriateness in different clinical situations. Their use can lead to improved patient outcomes and reduced economic burden of the disease.

This is a retrospective one tertiary centre study which investigated the humoral and cellular immunity reconstitution and clinical impact of chemotherapeutic protocols that included a single rituximab dose in children and adolescents treated for non-Hodgkin Lymphoma. The proportion of IgG, IgM, and IgA hypogammaglobulinemia decreased over the follow-up period. The median for B cell reconstitution was 3 months after the end of lymphoma treatment. Transitional B lymphocyte subsets dominated at the time of B cell subset reconstitution. No secondary antibody deficiency needing immunoglobulin replacement therapy was found.

During the COVID-19 pandemic, patients often died abruptly under the picture of circulatory and respiratory failure. The cause of this sudden deterioration remained hidden even after their death due to initial low number of the autopsies of COVID-19 positive patients. Fat embolism is a commonly overlooked cause of circulatory and respiratory failure, but it does not normally accompany viral infections and is therefore not standardly considered in their treatment. The authors present one of the first studies to relate these mechanisms based on microscopic examination with special staining of the specimens, shedding new light on the treatment of severe conditions of SARS-CoV-2 infection.

Detection of drug or its metabolite in a blood sample without evaluation of serum concentration does not fully enable uncovering instances of improper drug use or white-coat adherence. Considering pharmacokinetic properties of the drug helps us to recognize if measured concentration refers to steady state, i. e. regular use, or is markedly reduced and therefore originates from irregular or single dose ingestion before sampling. Application of pharmacokinetic principles in the interpretation of serum concentrations of antihypertensive drugs leads to a more precise evaluation of a patient's behaviour.

This work evaluates the effect of carteolol and latanoprost on vessel density in the peripapillary area of the optic nerve head. These drugs were chosen for two reasons: latanoprost is recommended by the European Glaucoma Society as the first-line drug for glaucoma. Carteolol works on a different principle but should not have any ischemic effect on the vascular system of the eye. In a previous study, during a 5-year follow-up of patients receiving beta-blockers (carteolol) and prostaglandins (latanoprost), the authors demonstrated a greater progression of visual field changes with prostaglandins than with beta-blockers. This led them, with the introduction of OCT angiography, to investigate whether they could detect changes in the vessels of the posterior pole of the eye in early-stage and newly diagnosed cases of primary open-angle glaucoma. The results showed that only patients treated with carteolol experienced a statistically significant improvement in vessel density.

This study evaluates the results of surgical transnasal procedures in patients with functioning pituitary adenomas. The cohort consisted of 58 patients. Microadenoma was diagnosed in 58.6% and macroadenoma in 41.4%. In the group with excessive production of ACTH, complete remission was achieved after the first surgery in 78.6% of cases; in the group with excessive GH production in 51.4%. In the group with excessive production of PRL, it was 57.1%. Surgical therapy in the cohort described led to the normalisation of excessive hormone production in 58.6% of cases.

High levels of oxidative stress, E-selectin, and microparticles are detected in HIV patients with and without ART. These abnormalities predisposed to the diseases associated with aging. There were no correlations between these biomarkers and viral suppression that is detected in peripheral blood. These results support the hypothesis that residual viremia in cellular reservoirs of various tissues is the key factor related to the premature aging of the immune system.