Pojem „personalizovaná medicína“ sa v posledných rokoch spomína čoraz častejšie v súvislosti so snahami čo najlepšie prispôsobiť medikamentóznu, ale aj režimovú liečbu potrebám a požiadavkám jednotlivých pacientov. Personalizácia antidiabetickej liečby prekonala svoj vývoj v kontexte nárastu poznatkov týkajúcich sa cukrovky. Od úrovne empirickej sa posunula na úroveň fenotypickú, ktorá umožnila rozlišovanie medzi jednotlivými typmi diabetu. V rámci diabetu 2. typu sa od 60. rokov minulého storočia aplikovala patogenetická personalizácia, ktorá vychádzala z predpokladov, že u niektorých pacientov prevažuje inzulínová rezistencia a u iných deficit sekrécie inzulínu. Bioštatistická personalizácia (medicína dôkazov) viedla k dôkazom, na základe ktorých bol metformín zaradený do odporúčaní pre liečbu diabetu 2. typu ako liek prvej voľby. Randomizované štúdie v prvom desaťročí 21. storočia síce nedokázali superioritu žiadnej z iných liečebných modalít ako prídavnej liečby k metformínu, ale viedli k individualizácii cieľov glykemickej kompenzácie. V súčasnej dobe sa personalizácia posúva na úroveň farmakogenetickú, od ktorej môžeme v najbližších rokoch očakávať individualizáciu liečby v zmysle výberu liekov prvej, druhej a tretej voľby v závislosti od panelu kľúčových génových polymorfizmov charakterizujúcich citlivosť jedinca na konkrétne antidiabetiká. V konečnom dôsledku by mala byť „liečba ušitá na mieru“ vybratá na podklade syntézy patogenetických, bioštatistických a farmakogenetických poznatkov, čo bude reflektovať transláciu výsledkov základného biomedicinískeho výskumu do klinickej praxe. Kľúčové slová: diabetes 2. typu – farmakogenetika – medicína dôkazov – patogenéza – personalizovaná liečba, In recent years, the term “personalized medicine“ has been increasingly mentioned in relation to the endeavours to tailor the pharmaceutical as well as regimen therapy to the needs and requirements of individual patients. The personalization of antidiabetic treatment has undergone a dramatic advancement in relation to the expansion of knowledge about diabetes. From the empirical it moved forward to the phenotypic level which made it possible to differentiate between individual types of diabetes. The pathogenetic personalization which began to be used within Type 2 diabetes in the 1960s, was based on the assumption that while insulin resistance predominates in some patients, others are mainly affected by insulin secretion deficit. Biostatistics-personalized medicine (evidence based medicine) gathered evidence based on which metformin was included in recommendations on the therapy for Type 2 diabetes as a first-line drug. Although randomized studies during the first decade of the 21st century did not prove superiority of any other treatment modality as an adjunctive therapy used with metformin, they brought with them individualization of the goals of glycemic control. At present, personalization is heading towards the pharmacogenetic level that will enable in the near future individualized therapy in terms of choice of first-, second- and third-line drugs depending on the panel of key gene polymorphisms which characterize sensitivity of an individual to specific antidiabetics. Finally, the “tailor-maded therapy“ should be chosen based on a synthesis of pathogenetic, biostatistic and pharmacogenetic knowledge that will reflect the translation of results of the basic biomedical research into the clinical practice. Key words: evidence based medicine – pathogenesis – personalized therapy – pharmacogenetics – type 2 diabetes, and Ivan Tkáč
Analysis of the stomach contents of otters recovered from South West England between 1999 and 2003 revealed that prey items taken were principally species of fish and amphibians, with mammals and birds occasionally taken. The fork length of fish recorded was 30 to 720 mm. Eel Anguilla anguilla was the dominant prey item, with up to five present per stomach. Estimated lengths ranged from 100 to 450 mm. Other common prey items were bullhead Cottus gobio and brown trout Salmo trutta. In addition to these freshwater species, there were recordings of sea bass Dicentrarchus labrax and thick lipped mullet Chelon labosus, indicating foraging in both freshwater and marine habitats. A seasonal peak was observed in the relative frequency of amphibians in diet, as otters took advantage of spawning aggregations. However, there were no seasonal trends in the relative frequency of other species in otter diet, with eel, bullhead and cyprinid species taken regularly in all months.
The concept of vena contracta space reduction in tricuspid valve position was tested in an animal model. Feasibility of specific artificial obturator body (REMOT) fixed to the right ventricular apex and interacting with tricuspid valve leaflets was evaluated in three different animal studies. Catheter-based technique was used in three series of experiment in 7 sheep. First acute study was designed for evaluation if the screwing mode of guide wire anchoring to the right ventricular apex is feasible for the whole REMOT body fixing. Longer study was aimed to evaluate stability of the REMOT body in desired position when fixing the screwing wire on its both ends (to the right ventricular apex and to the skin in the neck area). X-ray methods and various morphological methods were used. The third acute study was intended to the REMOT body deployment without any fixing wire. In all of 7 sheep the REMOT was successfully inserted into the right heart cavities and then fixed to the ri ght ventricular apex area. When the REMOT was left in situ more than 6 months it was stable, induced adhesion to the tricuspid valve leaflet and was associated with a specific cell invasion. Releasing of the REMOT from the guiding tools was also successfully verified. Deployment of the obturator body in the aim to reduce the tricuspid valve orifice is feasible and well tolerated in the short and longer term animal model. Specific cell colonization including neovascularization of the obturator body was observed., J. Sochman ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy