Acta medica (Hradec Kralove)最新文献

Contrast-induced sialadenitis (CIS), a rare inflammatory reaction of the salivary glands, occurs after exposure to iodinated contrast media (ICM). This self-limiting condition typically manifests as glandular swelling and pain, with variable severity, from hours to days post-contrast administration. Its etiology includes inflammatory edema, ductal obstruction, and pseudoallergic or idiosyncratic reactions. Non-ionic, low-osmolar agents such as Iohexol and Iodixanol are frequently implicated. Risk factors include iodine allergy, renal dysfunction, and inadequate premedication. Diagnostic imaging via CT or ultrasound reveals characteristic findings such as glandular enlargement, periglandular fat stranding, and heterogeneous enhancement, aiding differentiation from other causes like infection or neoplasms. This case series presents three patients who developed sialadenitis following contrast-enhanced CT scans. Presentations ranged from mild, localized submandibular swelling to rapid-onset bilateral glandular inflammation involving the parotid and submandibular glands. All cases highlight the need for prompt recognition and adherence to preventive measures, including premedication with corticosteroids and hydration, especially in high-risk patients. Management is largely supportive, involving corticosteroids, antihistamines, and NSAIDs, with severe cases requiring closer monitoring. By raising awareness of this underreported condition, this article underscores the importance of early recognition and differentiation from other conditions by radiologists, emphasizing their role in timely diagnosis and management. It also calls for further research to optimize prevention and management strategies.

The study aimed to establish the impact of age on the predictive capability of ferritin, ferritin-hemoglobin ratio (FHR), IL-6, and sIL-2R in COVID-19 patients. Compared to patients with moderate condition, patients with severe condition had higher ferritin level (441.0 [188.0-829.8] ng/mL vs 281.0 [172.0-388.0] ng/mL, p = 0.002), sIL-2R level (6.0 [4.7-9.0] pg/mL vs 5.3 [3.7-6.9] pg/mL, p = 0.020), FHR (38.4 [15.1-63.4] vs 22.0 [12.1-32.1], p = 0.002). The area under the curves (AUC) for discriminative capabilities of the following biomarkers for severe condition were assessed in patients aged <65 years and patients aged ≥65 years: ferritin (AUC = 0.585, p = 0.309 vs AUC = 0.683, p = 0.002), FHR (AUC = 0.589, p = 0.302 vs AUC = 0.688, p = 0.002), IL-6 (AUC = 0.503, p = 0.972 vs AUC = 0.647, p = 0.019), and sIL-2R (AUC = 0.549, p = 0.552 vs AUC = 0.646, p = 0.017). Also AUCs for discriminative capabilities for in-hospital mortality were compared in patients aged <65 years and ≥65 years: ferritin (AUC = 0.607, p = 0.628 vs AUC = 0.661, p = 0.105), FHR (AUC = 0.612, p = 0.621 vs AUC = 0.688, p = 0.002), IL-6 (AUC = 0.580, p = 0.724 vs AUC = 0.695, p = 0.016), and sIL-2R (AUC = 0.620, p = 0.491 vs AUC = 0.695, p = 0.029). Thus, ferritin, FHR, IL-6, and sIL-2R didn't show acceptable predictive value for severe condition and lethal outcome in patients aged <65 years but had high predictive value for lethal outcome in patients aged ≥65 years.

Edema of the psoas major muscle can indicate various pathologies, such as infection, malignancy, and trauma, but it can also result from benign causes like delayed-onset muscle soreness (DOMS). This article presents the case of a 44-year-old female patient who developed DOMS in the psoas major after participating in an intense abdominal workout. The patient reported hip pain that began a day after the workout, which was confirmed by magnetic resonance imaging (MRI) revealing significant edema in the psoas major muscles, particularly on the right side. Conservative treatment with rest and analgesics led to full recovery within two weeks. DOMS, typically associated with eccentric exercises, can be mistaken for more serious conditions, but its recognition is crucial to avoid unnecessary investigations and interventions. This case highlights the importance of clinical history and imaging findings in distinguishing DOMS from other causes of muscle edema, emphasizing the need for accurate diagnosis to ensure appropriate management.

A high-fructose intake (HFI) in food, sweetened beverages, and soft drinks appears to be one of the risk factors that worsens human metabolic and cardiovascular health, although the more accurate mechanism remains unclear. Hypertriglyceridemic (HTG) rats represent a suitable animal model of metabolic syndrome where the consumption of an HFI could have an additional aggravating impact. We aimed to study the effect of fructose on the heart functions. Male HTG rats had HFI or a standard diet for five weeks. Heart function was tested ex vivo on the perfused heart using the Langendorff technique. Isolated hearts underwent 25 min ischemia (I) and 30 min reperfusion (R). Left ventricular developed pressure (LVDP), ventricular premature beats, and dysrhythmias were monitored during R. At the end of the R, ventricular fibrillation (VF) was evoked electrically. Systolic blood pressure, glucose level, serum total cholesterol (TC), triglycerides (TAG), and thiobarbituric acid reactive substances (TBARS) in the kidney were determined. The LVDP showed a reduced return to the input values, the duration of VF in R increased, and the threshold for VF induction decreased. Serum TC, TAG, and kidney TBARS were increased. The effect of HFI on heart ventricular impairment was associated with the reduced threshold for induction of VF and aggravated dyslipidemia. The results point to the adverse impact of dietary high-fructose intake in rats with hypertriglyceridemia.

Introduction: Time series analysis is used by statisticians to make predictions from time-ordered data. This is crucial for planning for the future. The inclusion of little-known forecasting function in Excel™ has brought this type of analysis within the ability of less mathematically sophisticated individuals, including doctors. There are two main models for time series analysis: ARIMA (Autoregressive Integrated Moving Average) and exponential smoothing. This paper will demonstrate how the ubiquitous Excel facilitates a little-known sophisticated forecasting technique that employs the latter and presents a facilitating spreadsheet.

Methods: Excel's FORECAST.ETS function was invoked with supporting macros.

Results: A bespoke spreadsheet was created that would prompt for data to be pasted in columns A and B, formatted as a valid date in A and data in B. After error trapping and a horizon date, the FORECAST.ETS function calculates forecasts with 95% CI and a line graph. The FORECAST.ETS.CONFINT was also invoked using a macro to obtain a 95, 96, 97, 98 and 99% confidence intervals table.

Discussion: Forecasting is vital in all fields, including the medical field, for innumerable reasons. Statisticians are capable of far more sophisticated time series analyses and techniques and may use multiple techniques that are beyond the competence of ordinary clinicians. However, the sophisticated Excel tool described in this paper allows simple forecasting by anyone with some knowledge of this ubiquitous software. It is hoped that the spreadsheet included with this paper helps to encourage colleagues to engage with this simple-to-use Excel function.

Background: Research suggests that melanoma patients with low vitamin D levels exhibit a higher risk of tumor ulceration and increased tumor mitotic rates. This has led to investigations into the vitamin D receptor (VDR) gene concerning its potential link to melanoma susceptibility. This meta-analysis aims to explore the association between VDR FokI and TaqI polymorphisms and melanoma risk, with an emphasis on the need for research in diverse populations to enhance our conclusions regarding interactions between skin phenotypes and VDR variations.

Methods: A comprehensive literature search was conducted in databases, including PubMed, Scopus, and Web of Science, for studies linking VDR polymorphisms to melanoma risk, up to February 1, 2024. Keywords used included "Melanoma", "VDR", and various genetic terms. Quantitative synthesis was performed with Comprehensive Meta-Analysis (Version 4.0) and a significance threshold set at p < 0.05.

Results: A total of twenty-one case-control studies involving 8,813 melanoma cases and 7,973 controls were included. Twelve studies on FokI had 4,642 cases and 4,534 controls, while nine TaqI studies included 4,171 cases and 3,439 controls. The results show a significant association between the VDR FokI polymorphism and increased melanoma risk across four genetic models (allele model: OR = 1.128, 95% CI 1.026-1.241; P = 0.013; homozygote model: OR = 1.166, 95% CI 1.020-1.332; P = 0.025; heterozygote model: OR = 1.255, 95% CI 1.046-1.507; P = 0.015; dominant model: OR = 1.243, 95% CI 1.052-1.470; P = 0.011). In contrast, the TaqI polymorphism showed no significant association with melanoma risk in the general population.

Conclusions: This meta-analysis suggests that the VDR FokI polymorphism is linked to an increased susceptibility to melanoma, while the TaqI variant does not show a significant association. Future research should explore the interactions between VDR polymorphisms, skin phenotypes, and melanoma risk in diverse populations, with larger and more varied studies needed to confirm these findings and enhance our understanding of genetic factors affecting melanoma susceptibility.

Background: The cranial nerve (CN) V and adjacent neurovascular structures are crucial landmarks in microvascular decompression (MVD). MVD of CN V is the most effective treatment for patients with drug-resistant trigeminal neuralgia (TN) diagnosis. The endoscope-assisted retrosigmoid approach (RSA) provides better exposure and less cerebellar retraction in the corridor towards the cerebellopontine angle (CPA).

Methods: Five adult cadaver heads (10 sides) underwent dissection of the MVD in park bench position. MVD was simulated using microsurgical RSA, and the anatomical landmarks were defined. Microsurgical dissections were additionally performed along the endoscopic surgical path. Additionally, we present an illustrative case with TN caused by anterior inferior cerebellar artery (AICA) compression. The CN V and its close relationships were demonstrated. Endoscopic and microscopic three-dimensional pictures were obtained.

Results: This study increases the anatomical and surgical orientation for CN V and surrounding structures. The CN V arises from the lateral part of the pons and runs obliquely upward toward the petrous apex. It has motor roots that leave from pons antero-supero-medial direction to the sensory root. The endoscopic instruments provide perfect visualization with minimal cerebellar retraction during MVD.

Conclusion: MVD surgically targets the offending vessel(s) leading to TN and aims to create a disconnected area. The combination of preoperative radiographic assessment with and anatomical correlation provides safe and effective application while facilitating selection of the most appropriate approach. The RSA allows satisfactory visualization for CN V. Endoscope-assisted microsurgery through the CPA is a challenge, it should be performed with advanced anatomical knowledge.

Ovarian carcinosarcoma, also referred as malignant mixed Mullerian tumour, is an uncommon, highly aggressive and malignant neoplasm which makes up 1 to 4% of all ovarian tumours. It is biphasic involving both malignant sarcomatous (mesenchymal) and carcinomatous (epithelial) cells. There are various subtypes such as serous and endometrioid. However, the mesenchymal part is sarcomatous. About 90% of cases of ovarian carcinosarcoma spread outside the ovary. The two most accepted theories of origin for carcinosarcoma of the ovary are the collision and conversion theories. A third theory is the combination theory. Prognosis remains poor even when still localised in the ovary. In the last few years, there has been no change in the survival rate. The median survival rate is lower than 2 years. Clinical features mainly include lower abdominal pain and a palpable abdominal mass. Ovarian carcinosarcoma remains poorly understood and understudied. Being a rare tumour, elaborate therapeutic consensus is not available for ovarian carcinosarcoma. The main treatment involves cytoreductive surgery and then chemotherapy. The type of chemotherapy, role of radiotherapy and novel therapies need to be further studied. The main objective of this article is to review the current literature on carcinosarcoma of the ovary.

IgG4, a subclass of antibodies known as immunoglobulins have unique structural features, in particular, their Fc regions, that prevents their interactions with other receptors on effector cells and thus disabling them of activating complements system. IgG4 antibodies can undergo a process called Fab-arm exchange, wherein they exchange half-molecules with other IgG4 antibodies, thus forming bispecific monovalent antibodies. Isotypic switch in mature B cells in germinal centres of secondary lymphoid organs is controlled by Tfh subset of T cells. Functionally IgG4 antibodies exert immunomodulatory and blocking activities, modulating protective inflammation evolved by parasitic invasion and allergic inflammation. From the pathophysiological point of view, IgG4 autoantibodies are prominently observed in autoimmune diseases under the umbrella of IgG4-autoimmune diseases (IgG4-AID). Furthermore, IgG4-related diseases (IgG4-RD) are affecting various organs characterized by lymphoplasmacytic infiltrates and storiform fibrosis in tissues, together with elevated IgG4 levels in the blood. A better understanding of IgG4 immunobiology helps us diagnose and treat patients suffering from these rare forms of diseases.

Recent advancements in digital technologies have transformed clinical workflows in dentistry, ensuring precise restorations. Custom-made crowns and fixed partial dentures (FPDs) now rely on virtual articulation. The digital facebow provides individualized data for CAD settings, streamlining the fabrication via digital workflow. For the purpose of demonstrating the differences observed during fabrication, we present a case report involving a 68-year-old patient seeking a replacement for missing teeth 24, 25, 26, and 27. The treatment plan involved the fabrication of an implant-supported FPD using monolithic zirconia (ZrO2). However, technical hurdles emerged during the planning phase, primarily due to spatial limitations posing a risk of mechanical failure over time. Consequently, we pivoted approach towards a porcelain fused to metal (PFM) FPD. For the PFM FPD, individual values from the digital facebow adjusted both virtual and conventional articulators. For comparison, two ZrO2 FPDs were milled-individual settings and average settings. All restorations underwent assessment for occlusion in maximal intercuspal position and eccentric mandible movements. In conclusion, the case report showed that individualized PFM FPD required minimal adjustments compared to milled ZrO2 restorations, whether using individual or average values. Utilizing individual values from the digital facebow reduced operator working time and minimized the intraoral adjustments.