Cíle: Pseudoaneurysma intrarenálních arterií (RAP) může představovat život ohrožující komplikaci, k níž může dojít po parciální resekci ledviny. Autoři hodnotí incidenci RAP, u něhož zatím nedošlo k ruptuře (detekováno pomocí trojrozměrné CT angiografie – CTA), časně po minimálně invazivní parciální resekci ledviny (včetně laparoskopické a robotické operace). Dále hodnotí možnost využití nefrometrického skóre při predikci vzniku RAP. Metody: V období od února 2012 do listopadu 2013 podstoupilo 101 pacientů s renálními tumory minimálně invazivní parciální resekci ledviny. Tři až čtyři dny po operaci byla provedena CTA a radiologové (zaslepeně) diagnostikovali RAP. Pomocí logistického regresního modelu analyzovali autoři faktory, které mohou potenciálně ovlivňovat vznik RAP. Výsledky: Míra incidence RAP časně po minimálně invazivní parciální resekci (MIPR) byla nečekaně vysoká – 21,7 % (detekováno pomocí CTA). U pacientů s RAP byl přítomen signifikantně větší tumor (p = 0,02) a významně vyšší skóre parametru N indikující blízkost tumoru k renálnímu sinu (p = 0,01) než u pacientů, u nichž nedošlo ke vzniku RAP. Multivariátní analýza však prokázala, že ani celkové nefrometrické skóre ani hodnota jednotlivých komponent neměly významný vliv na vznik RAP. Velikost tumoru představovala jediný významný nezávislý prediktor vzniku RAP po minimálně invazivní resekci ledviny. Závěr: Parametr N nefrometrického skóre představuje významný prediktor vzniku RAP podle univariátní analýzy, nikoli však podle multivariátní analýzy. Komponentu N nefrometrického skóre tedy lze považovat za jeden z faktorů užitečných pro predikci vzniku RAP., Objectives: Renal artery pseudoaneurysm (RAP) can be a life threatening complication after partial nephrectomy. We investigated the incidence of unruptured RAP detected by 3-dimensional computed tomography arteriography (CTA) in the early period after minimally invasive partial nephrectomy (MIPN), including laparoscopic and robotic partial nephrectomy. We also examined the usefulness of nephrometry scoring system to predict the occurrence of RAP. Methods: From February 2012 to November 2013, 101 patients underwent MIPN for renal masses. CTA was performed 3–4 days after surgery, and the radiologists made a diagnosis of RAP in the blinded manner. The factors influencing the occurrence of RAP were analyzed with the logistic regression model. Results: The incidence of RAP was unexpectedly high at 21.7% when detected by CTA in the early period after MIPN. The RAP group showed a significantly larger tumor size (p = 0.02) and a significantly higher N component score (p = 0.01) compared to the No-RAP group. However, Neither the sum of nephrometry score nor each component showed significant influence on the occurrence of RAP according to the multivariate analysis. Tumor size was the only significant independent factor to predict the occurrence of RAP after MIPN. Conclusions: The N component of the nephrometry scoring system is a significant predictor for RAP by the univariate analysis, but not by the multivariate analysis. The N component of the nephrometry scoring system may be referred to as one of the factors predicting the occurrence RAP., and Kondo T., Omae K., Takagi T., Morita S., Hashimoto Y., Kobayashi H., Iizuka J., Yoshida K., Tanabe K.
Rekanalizace uzávěru velkých mozkových tepen je základem předpokladu příznivého výsledku léčby akutní ischemické cévní mozkové příhody (CMP). Intravenózní trombolýza provedená rekombinantním tkáňovým aktivátorem plazminogenu (rtPA) byla zkoumána v několika kontrolovaných randomizovaných studiích a ukázala se být bezpečnou a efektivní léčbou. Účinnost této léčby je střední. Mechanická trombektomie představuje další krok v léčbě akutní CMP. Několik prospektivních randomizovaných studií prokázalo pozitivní výsledky endovaskulární léčby u nemocných s proximálním arteriálním uzávěrem. Bylo nutné vyloučit nemocné s velkou zónou infarktu pomocí rychlých, efektivních zobrazovacích metod. Zásadní je logistika pacientů a dosažení rychlé rekanalizace s vysokou úspěšností. Použití stent retrieverů se prokázalo být vysoce efektivní jak technicky tak klinicky., Recanalization after large vessel occlusion is proven to be a crucial predictor for favorable outcome in acute ischemic stroke. Intravenous thrombolysis with recombinant tissue plazminogen activator (rtPA) has been investigated in several randomized controlled studies and is shown to be a safe and effective treatment. However, efficacy of this therapy is moderate. Mechanical thrombectomy represents further step in the treatment of acute stroke. Several prospective randomized studies proved benefit of the endovascular treatment based on proof of proximal artery occlusion, rapid and effective imaging methods to exclude patients with a large infarct core and efficient workflow to achieve fast recanalization and high recanalization rate. Using the stent-retriever technique proved to be highly technically and clinically effective., Antonín Krajina, Dagmar Krajíčková, and Literatura
Central administration of losartan effectively blocked the increase of blood pressure and drinking response induced by angiotensin II (Ang II) or carbachol. However, the relationship between angiotensin AT1 receptors and the natriuresis induced by brain cholinergic stimuli is still not clear. The purpose of the study is to reveal the role of brain angiotensin AT1 receptor in the carbachol-induced natriuresis and expression of neuronal nitric oxide synthase (nNOS) in the locus coeruleus (LC) and proximal co nvoluted tubule (PCT). Our results indicated that 40 min after in tracerebroventricular (ICV) injection of carbachol (0.5 μg), urinary sodium excretion was significantly increased to 0.548±0.049 μmol·min-1·100 g-1. Immunohistochemistry showed that carbachol induced an increase of neuronal nitric oxide synthase immunoreactivity (nNOS-IR) in the LC and renal proximal tubular cells. After pretreatment with losartan (20 μg), carbachol-induced urinary sodium excretion was reduced to 0.249±0.067 μmol·min-1·100 g-1. The same was true for carbachol-induced increase of nNOS-IR in the LC and PCT. The present data suggest that ICV cholinergic stimulation could induce a natriuresis and upregulate the activity of nNOS in the LC and PCT. The blockade of AT1 receptors might downregulate the effects induced by carbachol in the LC and PCT. Consequently, we provide a new evidence that brain angiotensinergic pathway and NO-dependent neural pathway contribute to the natriuresis following brain cholinergic stimulation and thus play an important role in the regulation of fluid homeostasis. Furthermore, the final effect of nitric oxide on proximal tubular sodium reabsorption participated in the natriuresis induced by brain cholinergic stimulation., M. Wang, C. L. Jiang, C. Y. Wang, Q. Y. Yao., and Obsahuje bibliografii a bibliografické odkazy
The pathogenesis of arterial hypertension in autosomal dominant polycystic kidney disease (ADPKD) is complex and likely dependent on interaction of hemodynamic, endocrine and neurogenic factors. We decided to evaluate the role of endothelin (ET1) and nitric oxide (NO) in the regulation of arterial blood pressure (BP) and to determine plasma levels of ET1 and NO in the group of patients with ADPKD. The ADPKD group (18 patients, 6 men + 12 women, mean age 44.611.7 years, with creatinine clearancecorrig > 1.1 ml/s) was compared with a control group of 27 healthy volunteers of comparable age. Plasma levels of ET1 assessed by direct RIA determination in the group of ADPKD patients (11.03±1.8 fmol/ml) were significantly increased (p<0.001) in comparison with the control group (2.660.58 fmol/ml), while no significant differences were observed between normotensive and hypertensive patients in the ADPKD group. Serum levels of NO were evaluated according to the determination of serum levels of their metabolites - nitrites/nitrates. Serum levels of NO in the group of ADPKD patients (39.85±6.38 μmol/l) were significantly higher (p<0.05) in comparison with the control group (22.7±1.20 μmol/l), whereas in the ADPKD group no significant differences were observed between normotensive and hypertensive patients. Thus, our study supports the concept of complex alteration of both vasoconstrictor and vasodilator systems in the pathogenesis of arterial hypertension in ADPKD., M. Merta, J. Reiterová, R. Ryšavá, V. Tesař, M. Jáchymová., and Obsahuje bibliografii
A short review on the role of endothelium and nitric oxide (NO) in experimental hypertension is presented in the light of the literature and our own recent findings. Based on these data, it is concluded that even though there is a lot of evidence in favor of the primary and causal association of endothelial dysfunction and NO in experimental hypertension, it seems still more plausible that they are causative in some types of hypertension only. Our own experience rather speaks for a secondary but still an important participation of endothelium in the maintenance and further elevation of high blood pressure. Endothelium plays a key role in the development of organ damages in hypertension., H. Vapaatalo, E. Mervaala, M.-L. Nurminen., and Obsahuje bibliografii
Ghrelin, an endogenous ligand for growth hormone secretagogue receptor (GHS-R), has been id entified in the rat and human gastrointestinal tract. Ghrelin has been proposed to play a role in gastric acid secretion. Nitric oxide (NO) was shown as a mediator in the mechanism of ghrelin action on gastric acid secretory function. However, there is a little knowledge about this topic. We have investigated the role of ghrelin in gastric acid secretion and the role of NO as a mediator. Wistar albino rats were used in this study. The pyloric sphincter was ligated through a small midline incision. By the time, saline (0.5 ml, iv) was injected to the control group, ghrelin (20 μg/kg, iv) was injected to the first experimental group, ghrelin (20 μg/kg, iv) +L-NAME (70 mg/kg, sc) was injected to the second group and L-NAME (70 mg/kg, sc) was administered to the third group. The rats were killed 3 h after pylorus ligation; gastric acid secretion, mucus content and plasma nitrite levels were measured. Exogenous ghrelin administration increased gastric acid output, mucus content and total plasma nitrite levels, while these effects of ghrelin were inhibited by applying L-NAME. We can conclude that ghrelin participates in the regulation of gastric acid secretion through NO as a mediator., H. M. Bilgin, C. Tumer, H. Diken, M. Kelle, A. Sermet., and Obsahuje bibliografii a bibliografické odkazy
In Britain, grey squirrels (Sciurus curolinensis Gmelin) and pheasants (Phasianus colchicus Linnaeus) are important hosts of larvae and nymphs of Ixodes ricinus L., the principal F.uropean vector of the Lyme disease spirochaete, Borrelia burgdorferi sensu lalo, T о test whether squirrels are competent hosts of B. burgdorferi s. I., three females were trapped in the wild and then held in captivity. Following treatment, each animal was exposed to uninfected xenodiagnostic I. ricinus ticks. Squirrel A (an adult) which was inoculated experimentally with B. burgdorferi s.l., transmitted the infection to xenodiagnostic ticks. In contrast, squirrel В (a juvenile that was not inoculated)-showed no evidence of infection. Xenodiagnostic ticks that fed on control squirrel С (an adult) became infected and subsequently transmitted the infection experimentally to an uninfected hamster. The results indicated that squirrel С had a disseminated infection acquired in the wild and which persisted for at least 11 weeks. These data clearly demonstrate that grey squirrels are amplifying and reservoir hosts of B. burgdorferi s.l. The strain associated with squirrels was related to the B. afzelii genotype. Two observations implicated pheasants in a similar role; (i) a high prevalence of infection in engorged larvae collected from trapped pheasants, and (ii) the detection of B. burgdorferi s.l. (В. garinii genotype) in the wattle of 1/10 pheasants using PCR. Xenodiagnostic experiments similar to those undertaken with the squirrels are needed to confirm the role of pheasants in the transmission cycle of Lyme disease spirochaetes.
The prevalence of obesity is increasing worldwide at an alarming rate in both developed and developing countries. Obesity is a chronic complex disease of multifactorial origin resulting from a long-term positive energy balance, in which both genetic and environmental factors are involved. Genetically prone individuals are the first to accumulate fat in the present obesogenic environment. Obesity increases the risks of type 2 diabetes, hypertension, cardiovascular disease, dyslipidemia, arthritis, and several cancers and reduces the average life expectancy. Implementation of effective strategies in prevention and management of obesity should be come an important target in health care systems. Weight changes throughout life depend on the interaction of behavioral, genetic and environmental factors. Weight loss in response to weight management shows a wide range of interindividual variation which is largely influenced by genetic determinants. The strong control of weight loss by genotype was confirmed by twin and family studies. Recently, special attention has been paid to nutritional, hormonal, psychobehavioral and genetic factors which can predict the response to weight reduction programme. In this article currently available data on the role of obesity candidate gene polymorphisms in weight loss and maintenance are reviewed. It is believed that an elucidation of the genetic component in the prognosis of weight management could assist in the development of more effective and individually tailored therapeutic strategies., V. Hainer, H. Zamrazilová, J. Spálová, I. Hainerová, M. Kunešová, B. Aldhoon, B. Bendlová., and Obsahuje bibliografii a bibliografické odkazy
The role of L-DOPA in spinal nociceptive reflex activity has been re-evaluated. In high spinal ca ts, with supraspinal loops being excluded, the onset of reflex facilitation induced by noxious radiant heat is delayed after injection of L-DOPA by 4 to 10 s, i.e. the early component of nociceptive reflex facilitation is blocked, while the late component persisted. Further investigations have shown that the early component of reflex facilitation induced by noxious radiant heat is mediated by Aδ-fibres and the late component by C-fibres. Therefore, it can be assumed that L-DOPA, like opioids, preferentially blocks the transmission in nociceptive reflex pathways from Aδ-fibres., E. D. Schomburg, P. Dibaj, H. Steffens., and Obsahuje bibliografii a bibliografické odkazy
Gastric mucus plays an important role in gastric mucosal protection. Apart from its “barrier” function, it has been demonstrated that mucus protects gastric epithelial cells against toxic oxygen metabolites derived from the xanthine/xanthine oxidase system. In this study, we investigated the effect of malotilate and sucralfate (mucus production stimulators) and N-acetylcysteine (mucolytic agent) on ischemia/reperfusion-induced gastric mucosal injury. Gastric ischemia was induced by 30 min clamping of the coeliac artery followed by 30 min of reperfusion. The mucus content was determined by the Alcian blue method. Sucralfate (100 mg/kg), malotilate (100 mg/kg), and N-acetylcysteine (100 mg/kg) were given orally 30 min before surgery. Both sucralfate and malotilate increased the mucus production in control rats. On the other hand, N-acetylcysteine significantly decreased mucus content in control (sham) group. A significant decrease of mucus content was found in the control and the N-acetylcysteine pretreated group during the period of ischemia. On the other hand, sucralfate and malotilate prevented the decrease the content of mucus during ischemia. A similar result can be seen after ischemia/reperfusion. In the control group and N-acetylcysteine pretreated group a significant decrease of adherent mucus content was found. However, sucralfate and malotilate increased mucus production (sucralfate significantly). Sucralfate and malotilate also significantly protected the gastric mucosa against ischemia/reperfusion-induced injury. However, N-acetylcysteine significantly increased gastric mucosal injury after ischemia/reperfusion. These results suggest that gastric mucus may be involved in the protection of gastric mucosa after ischemia/reperfusion., J. Mojžiš, R. Hegedüšová, L. Mirossay., and Obsahuje bibliografii