Biomedical Papers-Olomouc最新文献

Background: Minimally-invasive extracorporeal circulation (MiECC) is confirmed to mitigate the post-perfusion syndrome resulting in better outcomes in operated patients compared to the conventional cardiopulmonary bypass (ECC).

Aims: To determine whether there is a clinical benefit of lower blood loss in patients operated on MiECC compared to ECC. To provide a detailed construction of modified MiECC and its perfusion management.

Methods: Retrospective analysis of the clinical data of 60 patients undergoing coronary artery bypass grafting on MiECC or ECC. The primary outcome was to compare the following variables in the 2 groups: intraoperative and 30-day mortality and cardiovascular death, myocardial infarction and cerebral stroke (MACCE). Secondary outcomes included surgical revision for bleeding or tamponade, intraoperative and postoperative blood loss and the consumption of packed red blood cell units. We modified our MiECC by connecting a cardiotomy suction.

Results: There was no mortality, major adverse events or surgical revisions in either group. No difference was found for intraoperative blood loss. The MiECC group had significantly lower overall postoperative blood loss (660 mL vs 765 mL, P=0.037). Total consumption of packed red blood cell units was insignificantly higher in the ECC group (n=30 vs n=20, P=0.490).

Conclusion: MiECC is a safe alternative to conventional ECC in routine procedures such as CABG. Its improved biocompatibility was reflected by better preservation of hemostasis in this study.

Atrial fibrillation (AF), the most common cardiac arrhythmia globally, contributes significantly to morbidity and mortality. With advancements in implantable devices like pacemakers, defibrillators, and loop recorders, incidental detection of AF as device-detected AF (DDAF) or subclinical AF (SCAF) has become common. This asymptomatic AF presents unique management challenges, particularly in anticoagulation decisions for stroke prevention. Evidence from recent trials, notably NOAH-AFNET 6 and ARTESiA, indicates a complex risk-benefit profile for anticoagulation in DDAF. In ARTESiA, anticoagulation modestly reduced stroke and systemic embolism rates, though this effect did not reach statistical significance. The NOAH-AFNET 6 trial found no significant reduction in a composite of cardiovascular death, stroke, or systemic embolism with anticoagulation compared to placebo. Both trials revealed an increased bleeding risk, underscoring the need to carefully weigh stroke prevention against bleeding risks in DDAF. The 2024 European Society of Cardiology guidelines reflect this nuanced approach by advocating a tailored, risk-based strategy. Emerging evidence also shows that AF burden impacts heart failure (HF) outcomes, with a five-fold increase in HF hospitalizations associated with higher AF burden. This highlights the importance of rhythm or rate control to reduce HF progression, particularly in patients with both AF and HF, where reducing AF burden is associated with better prognosis and fewer hospitalizations. Future research should focus on refining anticoagulation strategies, especially for patients with low AF burden, and exploring novel approaches like intermittent anticoagulation and advanced monitoring to support personalized DDAF management.

Background and aim: Vibrio parahaemolyticus a gram-negative, rod-shaped bacterium with salinophilic properties is found mainly in rivers, oceans, and coastal environments. With the expanding scale of aquaculture in coastal regions of China, the contamination of seafoods with Vibrio parahaemolyticus is becoming a significant cause of food poisoning with symptoms including gastroenteritis, wound infection and sepsis. Current methods for detecting this microorganism are unsuitable in the present context. We developed a rapid LAMP-LFD method-by combining the loop-mediated isothermal amplification technique (LAMP) and lateral flow device (LFD).

Methods: The thermolabile hemolysin tlh gene of Vibrio parahaemolyticus was used as the target, and we designed five specific primers in its conserved region. The primers were used to carry LAMP reaction with biotin labelling, the products completed hybridisation with the FAM-labelled primers, and the hybridisation products were tested for results on LFD.

Results: The results showed that the LAMP-LFD method specifically detected Vibrio parahaemolyticus and was negative for proximate strains such as Vibrio vulnificus and other Vibrio pathogens as well as common pathogens such as Escherichia coli. The optimised reaction conditions for LAMP were 40 min at 60 °C, plus 5 min of probe hybridisation and 3-5 min of LFD color development. The lowest concentration of Vibrio parahaemolyticus pure culture bacterial fluid of 1.5×10² cfu/mL could be detected, and the pathogen could be detected from tissue samples with a contamination concentration of 0.75×10³ cfu/mL. The method has higher specificity and sensitivity, and the pathogen can be detected within 1.5 h.

Conclusion: The LAMP-LFD method for Vibrio parahaemolyticus established in this study has the advantages of convenient operation, low dependence on equipment, high sensitivity and rapid detection, all of make it ideally suited to the detection of Vibrio parahaemolyticus at the grass-roots level.

Objective: To determine changes in medication adherence in two cohorts of heart failure patients differing by year of data collection and using a direct method of adherence detection - serum drug level testing.

Methods: We added a second cohort of patients to a prospective monocentric registry of chronic heart failure patients (LEVEL-CHF registry). The two cohorts share the same inclusion criteria but differ by the year of enrolment (2018 and 2020). Stable patients with heart failure with reduced ejection fraction were enrolled in a specialized university hospital center.

Results: We included 402 records of 366 individual patients, 274 in 2018 and 128 in 2020. 36 patients were enrolled in both cohorts. Of the total 81% of patients were fully adherent, and 19% were non-adherent to a varying degree. Between 2018 and 2020 there was a statistically significant increase in BMI (P=0.047) and fasting glycemia (P=0.009). Patients in the 2020 cohort were less adherent than those in the 2018 cohort (P<0.01). Patients in the two cohorts had similarly severe heart failure and did not substantially differ in NYHA class. There were no statistically significant differences between adherent and non-adherent patients after adjusting for multiple comparisons.

Conclusions: In this comparison, most patients were fully adherent to all their medication and very few were non-adherent to multiple medications. We found no clinically relevant differences between adherent and non-adherent patients. Serum drug level testing is an effective method of adherence testing in clinical practice.

Background: The current requirement is to establish the preoperative diagnosis accurately as possible and to achieve an adequate extent of surgery. The aim of this study was to define the preoperative clinical and molecular genetic risks of malignancy in indeterminate thyroid nodules (Bethesda III and IV) and to determine their impact on the surgical strategy.

Methods: Prospectively retrospective analysis of 287 patients provided the basis of preoperative laboratory examination, sonographic stratification of malignancy risks and cytological findings. Molecular tests focused on pathogenic variants of genes associated with thyroid oncogenesis in cytologically indeterminate nodules (Bethesda III and IV). The evaluation included clinical risk factors: positive family history, radiation exposure and growth in size and/or number of nodules.

Results: Preoperative FNAB detected 52 cytologically indeterminate nodules (28.7%) out of 181 patients. Postoperative histopathological examination revealed malignancy in 12 cases (23.7%) and there was no significant difference between Bethesda III and IV categories (P=0.517). Clinical risk factors for malignancy were found in 32 patients (61.5%) and the presence of at least one of them resulted in a clearly higher incidence of malignancy than their absence (31.3% vs. 10.0%, respectively). Pathogenic variants of genes were detected in 12/49 patients in Bethesda III and IV, and in 4 cases (33.3%) thyroid carcinoma was revealed. The rate of malignancies was substantially higher in patients with pathogenic variants than in those without (33.3% vs. 16.2%, respectively).

Conclusions: Our experience implies that molecular genetic testing is one of several decision factors. We will continue to monitor and enlarge our patient cohort to obtain long-term follow-up data.

Introduction: Functioning pituitary adenomas lead to substantial morbidity and increased mortality associated with typical endocrine syndromes. Surgical therapy is an integral part of the management of these tumours. The aim of this study was to evaluate the results of surgical transnasal procedures in patients with functioning pituitary adenomas who underwent the surgery at the Department of Neurosurgery, University Hospital Olomouc.

Methods: Patients with functioning pituitary adenoma (ACTH, GH, PRL) were indicated for surgery. All patients underwent preoperative and postoperative endocrinological examination and laboratory tests to assess excessive or deficient hormonal production and imaging examination.

Results: The cohort consisted of 58 patients, 33 of whom were women and 25 men. The age range was 12-77 years (mean age 47.6 years). Microadenoma was diagnosed in 58.6% of patients and macroadenoma in 41.4% of patients. The most common hypersecretory syndrome was excessive production of growth hormone (56.9%), followed by excessive production of adrenocorticotropic hormone (24.1%) and prolactin (12.1%). In the group with excessive production of ACTH, complete remission was achieved after the first surgery in 78.6% of cases (72.8% for microadenomas (8) and 100% (3) cases in macroadenomas); in the group with excessive GH production in 51.4% (63.2% (7) in microadenomas and 46.2% (12) cases in macroadenomas). In the group with excessive production of PRL, it was 57.1% (100% (2) in microadenomas and 40% (2) cases in macroadenomas).

Conclusion: Surgical therapy in the presented cohort led to the normalisation of hormonal excessive production in 58.6% of cases. A combination of drug therapy and radiotherapeutic methods was necessary in the remaining cases to achieve hormonal remission.

Aim: Percutaneous transthoracic needle biopsy (PTNB), an alternative to bronchoscopic confirmation of lung lesions, is today being associated with a risk of pneumothorax and hemorrhage. Further, there are no data on the possible risk of malignant disease spreading to the pleura at the site of the PTNB. Previous studies have dealt with this risk in stage I non-small cell lung cancer only. The aim of this study was thus to assess the risk of pleural recurrence for all types of lung lesions. Secondary objectives included assessment of diagnostic yield and safety with respect to the incidence of pneumothorax and hemorrhage.

Methods: Clinical data of all patients from the University Hospital in Pilsen who had undergone PTNB of lung lesions between 1.1.2018 and 31.12.2022 were included in this retrospective study.

Results: Following PTNB, ipsilateral pleural effusion occurred in 4.8% of patients without prior pleural infiltration. The effusion was confirmed as malignant in one patient (0.7%). Diagnostic yield of the method was 86.6%. We recorded pneumothorax or hemorrhage in the lung parenchyma or pleural space requiring medical intervention in 3.4% and 1.1% of patients, respectively.

Conclusion: In our 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. Consequently, we continue to consider this method to be an alternative to bronchoscopy biopsies.

Background: Large vessel carotid stenosis is a significant cause of ischaemic stroke. Indications for surgical revascularisation depend on the severity of the stenosis and clinical symptoms. However, mild symptoms such as TIA (Transient ischaemic attack), amaurosis fugax or minor stroke precede large strokes in only 15% of cases.

Aim: The aim of this prospective study is to evaluate whether retinal perfusion is impacted in significant carotid stenosis. Automated retinal oximetry will be used to better assess perfusion in the post-stenotic basin. We presume the more stenotic the blood vessel, the more reduced the retinal perfusion is, resulting in adaptive changes such as greater arteriovenous saturation difference due to greater oxygen extraction. This could broaden the indication spectrum for revascularisation for carotid stenosis.

Methods: We plan to enroll yearly 50 patients with significant carotid stenosis and cross-examine them with retinal oximetry. The study group will provide stenotic vessels and, non-stenotic vessels will form the control group. Patients with significant carotid stenosis will undergo an MRI (Magnetic Resonnance imaging) examination to determine the presence of asymptomatic recent ischaemic lesions in the stenotic basin, and the correlation to oximetry parameters.

Statistics: The stenosis severity and retinal oximetry parameters will be compared for study and control groups with a threshold of 70%, respectively 80% and 90% stenosis. Results will be then reevaluated with emphasis on MRI findings in the carotid basin.

Conclusion: This prospective case control study protocol will be used to launch a multicentre trial assessing the relationship between significant carotid stenosis and retinal perfusion measured with automated retinal oximetry. Despite these differences, the findings indicate the potential of retinal oximetry for noninvasive real-time measurements of oxyhaemoglobin saturation in central nervous system vessels. Following calibration upgrade and technological improvement, verification retinal oximetry may potentially be applied to critically ill and anaesthesia care patients. The study on combined scanning laser ophthalmoscope and retinal oximetry supports the feasibility of the technique for oximetry analysis in newly born babies.

Trial registration: ClinicalTrials.gov, ID: NCT06085612.

Objectives: This study aims to identify factors possibly contributing to complications in children with acute leukaemia. Despite diverse etiological causes, similar processes trigger the process of cell malignancy. Genomic instability has received considerable attention in this context.

Method: We conducted chromosomal analysis of bone marrow cells and measured the micronuclei (Mn) level in buccal cells over time. Statistical reliability assessment was performed using Analysis of variance (ANOVA), and the data were analyzed and visualized using the SPSS 12 statistical analysis software package.

Results: On the 15th day of treatment, our findings confirmed a statistically significant correlation (χ²=3.88, P=0.04) between the number of blasts in the bone marrow and unfavourable outcome in patients with a near-tetraploid chromosome clone. Additionally, on the 33rd day of treatment, we observed a correlation between an elevated number of Mn and relapses.

Discussion: While it is commonly believed that a hyperdiploid clone with >50 chromosomes in childhood acute lymphoblastic leukaemia confers favorable outcome, our study revealed partially heterogeneous results and poor prognosis in patients with a near-tetraploid clone. We have also identified a correlation between the Mn level on the 33rd day of treatment and the development of complications. It is possible that the increased Mn values and the occurrence of relapses were influenced by the individual patient's sensitivity to the genotoxic effect of the medication.

Acute kidney injury (AKI) due to gentamicin nephrotoxicity is a significant concern in clinical medicine, particularly in patients receiving prolonged or high-dose gentamicin therapy. Gentamicin is an aminoglycoside antibiotic frequently used in the treatment of a range of bacterial infections. However, its use is associated with nephrotoxicity which can manifest as AKI. Due to this, it is crucial to diagnose promptly and manage treatment effectively. Ongoing studies are therefore focusing on non-protein-coding RNAs as potential biomarkers for AKI. Numerous microRNAs (miRNAs) have been implicated in gentamicin-induced nephrotoxicity and AKI. They participate in pathways associated with inflammation, cell death, and oxidative stress and each of these factors play critical roles in the development of gentamicin-induced kidney injury. Research studies have demonstrated changes in the expression levels of these miRNAs in response to gentamicin exposure both in vitro and in in vivo models, as well as in human clinical trials involving patients receiving gentamicin therapy. The dysregulation of these miRNAs correlates with the severity of kidney injury and may serve as sensitive biomarkers for early detection and monitoring of AKI induced by gentamicin.