Biomedical Papers-Olomouc最新文献

Background: Oxidative stress and inflammation are considered predictors of diseases associated with aging. Markers of oxidative stress, inflammation, and endothelial activation were investigated in people with HIV on antiretroviral treatment to determine whether they had an immunosenescent phenotype that might predispose to the development of premature age-related diseases.

Patients and methods: This study was conducted on 213 subjects with HIV. The control groups consisted of healthy HIV-negative adults. The level of oxidative stress was measured by assessing the production of malondialdehyde levels, which were detected by thiobarbituric acid reactive substance (TBARS) assay. The level of microparticles indicated the presence of inflammation and endothelial activation was measured by E-selectin levels. Significant differences were determined by appropriate statistical tests, depending on the distribution of variables. Relationships between continuous variables were quantified using Spearman's rank correlation coefficient.

Results: TBARS, and microparticle and E-selectin levels were significantly higher in untreated and treated subjects with HIV compared with HIV-negative controls (P<0.001). The levels of the investigated markers were not significantly different between untreated and treated patients and no significant correlation of these markers was found with CD4⁺ count, CD4⁺/CD8⁺ ratio, and the number of HIV-1 RNA copies.

Conclusions: Elevated markers of oxidative stress, inflammatory and endothelial activation were independent of the virologic and immunologic status of people with HIV. These results support the hypothesis that residual viremia in cellular reservoirs of various tissues is a key factor related to the premature aging of the immune system and predisposition to the premature development of diseases associated with aging.

Aims: The objective of this study was to investigate the association and combined prognostic significance of the PD-L1, Smoothened protein and β-catenin expressions in patients with clear cell renal cell carcinoma (ccRCC).

Methods: The PD-L1, Smoothened protein and β-catenin expression were evaluated in 104 ccRCC patients. All studied tumor samples were acquired from nephrectomy specimens of primary tumors and not from biopsies or metastases. An indirect immunohistochemistry using polyclonal rabbit anti-Smoothened antibody, monoclonal mouse anti-human β-catenin-1 antibody, immunohistochemical assay PD-L1 28-8 pharmDx using monoclonal rabbit anti-PD-L1 antibody and anti-VHL (C- terminal) rabbit antibody was used. Immunohistochemistry was scored semiquantitavely.

Results: Median overall survival (OS) was significantly better in patients with lower PD-L1 expression (≤5%), Smoothened protein (SMO) expression (<5%) or cytoplasmic β-catenin expression (≤75%) than in patients with higher expressions of these biomarkers (P<0.001, P=0.047, and P<0.001, respectively). Membranous β-catenin showed an opposite effect with its lower expression (≤75%) being associated with longer OS (P=0.020). There was significant association between PD-1 and PD-L1 expression (P=0.007) and significant association of tumor grade (WHO 2016) with membranous β-catenin (P<0.001), cytoplasmic β-catenin (P=0.005), pVHL (P=0.042), PD-L1 (P=0.049) and PD-1 (P=0.028) expression.

Conclusion: The present study provides the first data on the potential association and combined prognostic significance of frequency of primary cilia, PD-L1, Smoothened protein and β-catenin expression with the outcome in clear cell renal cell carcinoma.

Introduction: Macular pigment plays an important role in the reduction of oxidative stress and in preventing retinal diseases. Quick and easy measurements of the macular pigment are essential in both clinical and research settings. Dual wavelength fundus auto-fluorescence seems to be the optimal method. This study aims to investigate changes in fundus autofluorescence in patients taking daily lutein oral supplements and develop image processing methods for follow-up evaluations of the images.

Methods: New devices allow us to examine fundus autofluorescence using both blue and green excitation wavelengths. This allows detection of the amount of macular pigment by subtracting these two images because the yellow pigment particles absorb blue wavelengths. We determined daily dose of 25 mg of lutein and 3 mg of zeaxanthin. Patients were followed up for 15 months at 3-month intervals.

Results: During our 15-month study, we observed a positive trend in pixel lightness values, suggesting an increase in macular pigments in the foveal area. In all patients taking daily lutein supplements, the foveal index significantly increased after six months, with a median change of 0.081. We did not observe a significant change after the first three months (0.006) and only a small change between the 6th and 12th-month visits (0.012).

Conclusion: With appropriate patients and procedures for capturing autofluorescence images, this is a valuable technique for macular pigment evaluation in follow-up examinations using software image post-processing and analysis with commonly available hardware. To put this into everyday practice, developing tools to automate the assessment is necessary.

Aims: Fibromyalgia (FM) is a chronic, widespread musculoskeletal disease that is usually accompanied by hyperalgesia, fatigue, sleep disturbance and depression. Although the etiopathogenesis of this syndrome is unclear, it is presumed to have an inflammatory basis. There are currently no laboratory markers available to diagnose the condition. The aim of this study was to investigate potential biochemical markers that would prove to be valid, simple, routinely used, quickly and cheaply studied and obtainable in blood count tests.

Methods: 46 patients diagnosed with FM according to ACR (American College of Rheumatology) 2010 diagnostic criteria and 35 patients as a healthy control group were included in the study. Prealbumin, complete blood count, sediment and C-reactive protein (CRP) values of FM and control group patients were examined. Additionally, Hospital Anxiety and Depression Scale, Jenkins Sleep Scale and the Fibromyalgia Impact Questionnaire (FIQ) were administered to patients diagnosed with FM.

Results: There was a significant difference between fibromyalgia patients and control groups in terms of prealbumin, platelet, CRP, CRP/prealbumin and lymphocyte parameters (P=0.048, P=0.046, P<0.001, P=0.003 and P<0.001, respectively). Only a weak positive correlation was found between CRP and FIQ (r_S =0.309, P=0.037, CI=0.012-0.556).

Conclusion: The serum levels of some tested markers, including platelets, CRP, CRP/prealbumin and lymphocytes, were significantly higher and prealbumin was lower in patients with FM than in the control group, suggesting they could be valid in fibromyalgia diagnosis. The CRP level may be informative about the severity of the FM and it may play a role in the inflammation possibly underlying the pathogenesis of FM.

Background and aims: Chronic spontaneous urticaria (CSU) is a skin condition causing red, raised, itchy and sometimes painful hives which lasts longer than six weeks. While the cause is unclear, the Urticaria Activity Score-7 (UAS-7), can help to determine the severity of the disease while the Systemic Immune Inflammation Index (SII) defined as neutrophils × platelets/lymphocytes, is a recent marker that shows the inflammatory and immune status and can be easily calculated from routine blood tests using neutrophil, lymphocyte, and platelet counts. We aimed to determine whether the SII correlates with UAS-7 in CSU patients.

Methods: We conducted this study on 245 patients with CSU. The UAS-7 score was obtained from all patients. Four groups were generated according to the UAS-7 score as ≤6, 7-15, 16-27, and 28-42. The correlation between the UAS-7 score and SII was evaluated.

Results: There was a statistically significant difference between the groups in terms of white blood cell count, neutrophil count, platelet count, Neutrophil-lymphocyte ratio (NLR), Platelet- lymphocyte ratio (PLR), and SII (P<0.05). A positive correlation was found between SII, NLR and PLR, and UAS-7 score. The strongest correlation was between SII and UAS-7, with P<0.001, r=0.642.

Conclusion: SII, which is easy to calculate, practical, and objective can be used for predicting the severity of the urticaria and for guiding the follow-up and treatment of these patients.

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.