The ROS-generating photosensitizer-free NaYF4:Yb,Tm@SiO2upconverting nanoparticles for photodynamic therapy application.

In this work we adapt rare-earth-ion-doped NaYF4nanoparticles coated with a silicon oxide shell (NaYF4:20%Yb,0.2%Tm@SiO2) for biological and medical applications (for example, imaging of cancer cells and therapy at the nano level). The wide upconversion emission range under 980 nm excitation allows one to use the nanoparticles for cancer cell (4T1) photodynamic therapy (PDT) without a photosensitizer. The reactive oxygen species (ROS) are generated by Tm/Yb ion upconversion emission (blue and UV light). Thein vitroPDT was tested on 4T1 cells incubated with NaYF4:20%Yb,0.2%Tm@SiO2nanoparticles and irradiated with NIR light. After 24 h, cell viability decreased to below 10%, demonstrating very good treatment efficiency. High modification susceptibility of the SiO2shell allows for attachment of biological molecules (specific antibodies). In this work we attached the anti-human IgG antibody to silane-PEG-NHS-modified NaYF4:20%Yb,0.2%Tm@SiO2nanoparticles and a specifically marked membrane model by bio-conjugation. Thus, it was possible to perform a selective search (a high-quality optical method with a very low-level organic background) and eventually damage the targeted cancer cells. The study focuses on therapeutic properties of NaYF4:20%Yb,0.2%Tm@SiO2nanoparticles and demonstrates, upon biological functionalization, their potential for targeted therapy.

Exercise and nitrite prevent and Nω-nitrol-L-arginine methyl ester reproduces imbalance in the nuclear factor-κB/NADPH oxidase 2 and nuclear factor erythroid 2-related factor 2/NADPH oxidase 4/endothelial nitric oxide synthase systems in diabetes.

Diabetes-induced vasculopathies are linked to inflammation mediated by mutually inhibitory nuclear factor-kappaB (NF-κB) and nuclear factor erythroid 2-related factor 2 (Nrf2). NF-κB is activated by superoxide (O2 ˙-)- producing nicotinamide adenine dinucleotide phosphate (NADPH) oxidase homologues, including NADPH oxidase 2 (Nox2), and vice versa, with NF-κB inducing Nox2. Nrf2 is activated by H2O2-producing Nox4 and nitric oxide (NO), but also induces NADPH oxidase 4 (Nox4) and endothelial nitric oxide synthase (eNOS). The NF-κB/Nox2 system is upregulated and Nrf2/Nox4/eNOS is downregulated in diabetes. We hypothesized that this vascular-deleterious imbalance results from the reduced vascular NO signaling, and so may be prevented by exercise training and sodium nitrite (interventions known to replenish vascular NO), and be reproduced by nitric oxide synthase (NOS) inhibition. Streptozotocin diabetic rats were examined on days 4, 10, 49 and 84 of diabetes. From day 4 onwards, plasma nitrite was reduced while NF-κB nuclear accumulation in the heart and kidneys gradually increased, while Nrf2 decreased. In parallel, the cardiac expression of signatures of the NF-κB (inducible nitric oxide synthase (iNOS), vascular cell adhesion molecule-1 (VCAM-1), NADPH oxidase 2 Nox2) increased and of the Nrf2 (Nox4, eNOS, heme-oxygenase-1 (HO-1)) decreased. Exercise training and dietary nitrite prevented this phenotype in the 49-day diabetes model. 7-day treatment of non-diabetic rats with NOS inhibitor of Nω-nitro-L-arginine methyl ester (L-NAME) recapitulated the NF-κB/Nox2 and Nrf2/Nox4/eNOS imbalance, as seen in diabetic rats. Nitrite failed to prevent the changes induced by L-NAME. The coherence of changes in NF-κB, Nox2, Nrf2, Nox4 and eNOS under the various settings of this study aimed at modifying the vascular NO leads us to propose that NF-κB/Nox2 and Nrf2/Nox4/eNOS are two crosstalking functional subsystems of one larger regulatory network, with NOS-derived NO ensuring the balance between these subsystems, and thus preventing vascular oxidative stress, endothelial dysfunction and inflammation.

Oncosurgery in the Czech Republic.

The article describes the development of oncosurgery in the Czech Republic since the beginning of the century, as well as other perspectives regarding this specialty. The development of surgical treatment of solid malignant tumours in the Czech Republic was evaluated according to the National Cancer Register database and compared to the neighbouring countries, and the educational system of surgeons in oncosurgery was assessed. Although surgery plays a key role in cancer therapy, starting from the beginning of this millennium it has been pushed aside as a service specialty for other disciplines in oncology. In 2002, these changes were supported by the activities of the newly founded Division of Oncosurgery under the Czech Society for Oncology, which became part of the Czech Surgical Society in 2016. An official educational programme of surgeons in oncology was successfully implemented and since 2011, a specialization examination in oncosurgery has been introduced, organized by the subdepartment of oncosurgery of the Institute of Postgraduate Medical Education (IPVZ), Prague. To date, this examination has been completed by 112 physicians and approximately the same number is currently registered in the educational programme. Currently, 34 centres are accredited for education in oncosurgery. The establishment of Complex Oncology Centres based on an initiative of the Czech Society for Oncology of 2006 only addressed pharmaceutical and radiation oncology. Despite progress in oncosurgery, more clearly defined conditions for this specialty are needed. Conclusion: The education of surgeons in oncosurgery should be continued. It is necessary to expand the number of centres with accreditation for oncosurgery and develop a concept for oncosurgery in the Czech Republic which would be associated with rational concentration of this treatment in connection with organization and provision of continuous urgent and acute surgical care in the Czech Republic, including control mechanisms to ensure its quality. This proposal should be discussed by the Czech Surgical Society in order to further enhance the quality of oncosurgery in the Czech Republic.

Risk factors and post-operative complications after gastrectomy for cancer.

INTRODUCTION: Gastric resections due to carcinoma belong to the most demanding procedures in visceral surgery. This is due to the requirements for the extent of resection and lymphadenectomy, coupled with the need for functional reconstruction of the digestive tract. The procedure is associated with 18-46% morbidity, which delays administration of adjuvant therapy and worsens oncological results. Identification of risk factors for potential complications may play an important role in the indication and perioperative care. The aim of our study is to (i) evaluate the morbidity a mortality of a patient group with post-gastrectomy complications and to (ii) identify associated risk factors. METHOD: This retrospective analysis comprises patients treated in 2005-2016. Gastric resection was performed in 266 adenocarcinoma patients, 172 men and 94 women (median age 66 years). Early post-operative complications following gastrectomy were observed within 60 days. Complications and their severity were evaluated according to the extended form of the Accordion Severity Grading System. Selected demographic risk factors, operative factors and malignancy-related factors were analyzed. Multivariate regression (orthogonal projections to latent structure) was used for statistical processing. RESULTS: Overall morbidity and mortality was 34.6% and 3.4%. Serious complications occurred in 51 operated patients (19.2%). 24 patients had two or three complications (9%). The most common grades of severity were grade 2 in 31 patients (11.7%) and grade 4 in 20 patients (10.9%). The duration of hospital stay correlated with the severity of the complication. Most common surgical complications were: intra-abdominal abscess (16.4%, 17 cases), wound complications (5.3%, 14 cases), pancreatitis (4.9%, 13 cases), anastomotic leakage (3.4%, 9 cases), postoperative ileus (3.4%, 9 cases). Respiratory and cardiac complications were the most common non-surgical complications (8.6%, 23 cases and 3.8%, 20 cases, respectively). In the derived statistical model, BMI, the presence of more comorbidities, lesser surgical experience, the length of hospital stay and hospitalization at ICU were identified as risk factors associated with the grade of complication, morbidity, presence of serious complication and multiple complications. CONCLUSION: Gastrectomy plays a fundamental role in the curative treatment of gastric carcinoma; it is, however, associated with substantial morbi-dity and mortality. The best management of complications is their prevention. Preoperatively, the greatest attention should be paid to patients with several comorbidities and higher BMI. Resections should be performed by experienced surgeons. During resection, consideration should be given to the extent of resection and lymphadenectomy. In the postoperative period, the length of hospital stay, especially at ICU, should be reduced to minimum. Analyses of these risk factors may decrease the incidence of complications. Key words: gastric cancer - gastrectomy - risk factors - complications.

Hybrid thoracoscopic esophagectomy for cancer - retrospective analysis and comparison with transhiatal resection.

INTRODUCTION: Minimally invasive methods for esophagectomy have been introduced to reduce postoperative complications. This paper compares open transhiatal esophagectomy and minimally invasive hybrid esophagectomy. Both methods have different extents of lymphadenectomy, transhiatal esophagectomy being considered less radical. METHOD: A single-centre retrospective study comprised 39 patients subjected to transhiatal esophagectomy and 25 patients subjected to hybrid esophagectomy combining thoracoscopy with laparotomy and cervical anastomosis. All patients were operated for middle and distal third carcinoma of the esophagus, including cardia (Siewert II), in the period of 2006-2016 at the Surgery department of Nový Jicín hospital. The data of both groups, in particular the incidence of early postoperative complications and the number of dissected lymph nodes, were statistically compared. Complications are reported according to the International Consensus on Standardization of Data Collection for Complications Associated with Esophagectomy. RESULTS: The duration of operation was significantly longer in the group that underwent hybrid resections (345 vs. 240 min, p<0.001). The number of dissected lymph nodes was comparable in both groups (15 vs. 16, p=0.072). Postoperative pulmonary complications were lower for hybrid operations (16% vs. 30.8%, p=0.243). The most common complication of transhiatal esophagectomy was pleural effusion requiring drainage, which occurred in 7 patients. The most common pulmonary complication of hybrid procedures was respiratory failure, which occurred in 3 patients. Anastomotic leak occurred in 5 patients after transhiatal esophagectomy and in one after thoracoscopic resection (12.8% vs. 4%, p=0.391). 30-day and 90-day mortality was nonsignificantly lower for hybrid resections (0% vs. 5.1%, p=0.516 and 4% vs. 10.3%, p=0.64). Following transhiatal esophagectomy, two patients died as a result of respiratory complications, one died from necrosis of the gastric tube and one from acute myocardial infarction. In the hybrid group, one patient died from respiratory failure. Hybrid resection exhibited lower morbidity (36% vs. 59%, p=0.123). The number of overall complications, irrespective of their severity according to the Clavien-Dindo classification, was statistically in favor of hybrid resection (11 vs. 30, p=0.015). CONCLUSION: In our study, we found that thoracoscopic hybrid resection was a feasible and well-executable method, with a statistically lower incidence of postoperative complications. Thoracoscopy allows lymphadenectomy to be performed to sufficient extent. The large number and various combinations of esophagectomy techniques make it difficult to evaluate and compare the outcomes of individual methods. Preference for a specific resection technique within a given surgical department remains an important factor as clear recommendations for esophageal resections do not yet exist. However, the use of minimally invasive techniques in esophageal resections is gradually becoming a standard. Key words: minimally invasive esophagectomy - thoracoscopy - postoperative complications - lymphadenectomy.

Prophylactic ligation of the thoracic duct in the prevention of chylothorax after esophagectomy.

INTRODUCTION: Chylothorax after esophageal resection is an uncommon but serious complication with a reported incidence of 1-10%. It occurs after the injury of the thoracic duct or its tributaries. Chylothorax may cause an overall loss of several liters per day and may lead to dehydration, malnutrition and immunosuppression. Therapeutic approach has not been standardized. Prophylactic ligation of the thoracic duct during primary resection has been introduced to decrease the overall incidence of chylothorax. Its oncological benefit is unknown. METHOD: A retrospective single-center study of patients who underwent transthoracic esophagectomy from 2008-2016 for esophageal carcinoma at the Department of Surgery, Hospital Nový Jicín. 58 patients underwent transthoracic esophagectomy (Ivor-Lewis and McKeown). Prophylactic ligation of the thoracic duct was performed in 31 patients (53%). The incidence of chylothorax and the amount of harvested lymph nodes was analysed in the group with thoracic duct ligation (A PTDL 31 patients) and in the non-ligation group (B 27 patients). RESULTS: Overall incidence of chylothorax after transthoracic esophagectomy was 3.4%. Chylothorax occurred in two men (type 3B) in the prophylactic group (6.5%) and it was not observed in the non-ligation group. Statistically significant difference was not confirmed (p=0,494). Chylous leak was successfully treated thoracoscopically and by thoracotomy with repeat ligation of the thoracic duct. Non-significantly more lymph nodes were harvested in the prophylactic group (18 A PTDL vs. 15 B, p=1). CONCLUSION: Prophylactic ligation of the thoracic duct in our study did not reduce the incidence of chylothorax. Redo thoracotomy and redo thoracoscopy for chylothorax is feasible. In patients with high-output and long lasting leaks the indication for redo surgery should be early. Key words: chylothorax - esophageal resection - prophylactic thoracic duct ligation.

Current state of surgical treatment of cancer of the stomach and gastro-esophageal junction in the Czech Republic.

INTRODUCTION: Analysis of the epidemiology and treatment of cancer of the stomach (CS) and gastro-esophageal junction (GEJ) in the Czech Republic (CR). METHOD: Analysis from the National Cancer Registry (NCR) of the CR examined data up to the year 2013. RESULTS: In CS and GEJ, the incidence is 14.3, mortality is 10.5 and prevalence is 51.1 per 100,000 population. The Karlovy Vary, Olomouc and Moravian-Silesian regions had the highest incidences. The median age at diagnosis is 69 years for men and 72 years for women. Location in the stomach prevails in 85% of the patients, cancer of the gastric cardia occurring in 15%. In men, this ratio is 81 to 19%, in women 90 to 10%. The disease is usually diagnosed late; in 2013, 36% of CS and 32% of GEJ tumors were stage I and II. 53% of CS and 56% of tumors of the GEJ were diagnosed as stage III and IV, and in 11% and 12%, the stage was not determined. In the years 2009-2013 (1,580 patients with CS and GEJ), only 22% were treated surgically, surgery and oncological treatment was given to 21.3%, only non-surgical treatment was received by 15.7% and 41% of patients received no oncological treatment. Overall five-year survival in patients treated between 2010 and 2013 was 32%. At stage I it was 69%, at stage II 41%, at stage III 23% and at stage IV it was 6%. Five-year survival rates according to disease stage and type of treatment given and median of survival were analysed on 8,348 patients with CS and GEJ between 2004 and 2013. Surgery only was performed in 4,116 patients, surgery and radiotherapy was administered to 113 patients, surgery and chemotherapy to 1,855 patients, and 1,125 patients received chemotherapy alone. In 98% of the treated patients, chemotherapy and/or radiotherapy was administered adjuvantly after the surgery. Primary operations were performed at a total of 175 surgical centers, only 22 of them performing more than 10 operations annually. The median of survival differed depending on the number of operations performed: at enters performing more than 20 operations, the median was 24.8 months (m); at enters performing 10-19 operations, the median was 18.2 m; at centers performing 6-9 operations the median was 18.1 m; and at centers performing less than 6 operations, the median was 13.1 m. CONCLUSION: Early diagnosis is key for five-year survival. Treatment is based on surgery; greatest improvement is seen when surgery is combined with chemoradiotherapy, which is usually administered adjuvantly in the CR. At stage I in CS +9.5%, GEJ cancer +26.5%, at stage II in CS +14.7%, GEJ cancer +16.4% and at stage III in CS +13.3%, GEJ cancer +2.6%. Palliative chemo and/or radiotherapy does not prolong five-year survival and must be selected on an individual basis with regard to the expected benefit for the patient. Facilities performing a greater number of surgical procedures have better long-term results. Key words: malignant esophageal tumors - epidemiology - treatment - results.

Coverage of multiple recessions using the tunnel technique and a collagen matrix in the maxilla or mandible: a 6-month study.

Multiple recession defects in the dentition of the patients are routinely encountered in clinical practice and as such present a challenge for clinicians. Periodontal plastic surgical procedures aim to restore both esthetics as function in periodontal tissues. The objective of this study was to evaluate and compare the clinical efficacy of using a tunnel technique with a collagen matrix to cover multiple recessions in the maxilla or mandible. Fourteen patients were enrolled in the study. Patients in the maxilla-group and mandible-group were treated with xenogeneic collagen matrix using the tunnel technique. Clinical recordings were obtained at baseline and after 3 and 6 months. The percentage of average recession coverage (ARC), the percentage rate of patients with complete coverage of all recessions (CRC-1) and the percentage rate of complete coverage of recession defects (CRC-2) were evaluated after 3 and 6 months after the surgery. Statistically significant differences were observed in every parameter except probing depth between the baseline values compared to the values 3 and 6 months after the procedure in both groups. The mean ARC 6 months after the procedure was 96.8% in the maxilla and 81.3% in the mandible. At 6 months after the procedure, a complete root coverage was obtained in 2 out of 9 patients and 31 out of 39 recessions (79%) in the maxilla and 0 out of 5 patients and 10 out of 20 recessions (50%) in the mandible. A collagen matrix combined with the tunnel technique led to a satisfactory ARC, CRC- 2 and resulted in an unsatisfactory CRC-1.

[Sternal resection for metachronous metastasis from renal carcinoma]. / Resekce sterna pro metachronní metastázu karcinomu ledviny.

In this report, the authors describe a rare case of complete sternal resection for a metachronous metastasis from renal carcinoma in a 59-year-old female patient 12 years after primary left nephrectomy. Due to the large extent of resection, a polyester double layer mesh with bone cement was used for chest wall reconstruction. The postoperative course was uneventful without any indication for adjuvant treatment. The patient has been followed up for 20 months without any signs of complications and recurrence of her malignancy.Key words: sternum resection bone metastases renal carcinoma.

[Gastric stump cancer--unicentric analysis of 7 patients]. / Karcinom zaludecního pahýlu--unicentrická analýza 7 pacientu.

INTRODUCTION: Gastric stump cancer accounts for 14% of all gastric carcinomas. Originally this term included patients who previously underwent surgery due to peptic ulcer disease but today gastric stump cancer also includes patients diagnosed some time after primary gastric resection due to gastric cancer. The incidence is increasing. Gastric stump cancer is associated with poor prognosis and its reported resecability is around 40%. METHODS: We retrospectively analyzed the data of 7 patients with a preoperatively histologically confirmed stump cancer who had been operated at the Department of Surgery at Nový Jicín Hospital during 2006-2014. RESULTS: We operated 5 men and 2 women with the median age of 70 years (5580). The primary surgical resection in all our patients was BII gastric resection due to peptic ulcer disease, and GSC had evolved within a median of 38 years (3246) after primary intervention. None of the patients had been regularly screened by endoscopy following primary surgery. We performed five curative resections (four total gastrectomies, one subtotal gastrectomy). Our resecability rate was 71%. In two cases, only explorative laparotomy was performed due to generalisation of the malignancy. Two patients from the resected group died after 30 and 34 months due to progression of their disease; the other three patients are still alive after 17, 19 and 88 months. CONCLUSION: Gastric stump cancer is a malignancy often diagnosed in its late stages. Regural endoscopic screening after primary gastric resection for benign disease can lead to diagnosis at an earlier stage, thereby improving the resection rate and overall survival. This also applies to long-term follow-up of patients with primary subtotal gastrectomy for cancer. Lymphatic metastasizing of the carcinoma can often be different due to the previous surgical intervention and altered anatomy. This must be taken into account during operations.

[Colon cancer - evaluation of complications and risks of planned resections]. / Karcinom tlustého streva - zhodnocení komplikací a rizik plánovaných resekcních výkonu

INTRODUCTION: Resection procedures for colorectal cancer are burdened with a relatively high number of complications. The aim of this study is to define risk factors associated with the development of postoperative complications based on retrospective data analysis. MATERIAL AND METHODS: From January 1 st 2007 to December 31st 2012, 1093 patients underwent surgery for colorectal cancer. Retrospectively, we selected a group of 406 patients who underwent planned, elective colon resection for colon cancer. Open surgery was performed in 158 patients (38.9%), laparoscopic resection in 248 patients (61.1%). Based on initial staging of the disease, there were 85 patients (20.9%) in stage I, 137 patients (33.8%) in stage II, 110 patients (27.1%) in stage III and 74 patients (18.2%) in stage IV. Postoperative complications were evaluated according to Clavien - Dindo classification. RESULTS: Grade I complications were observed in 34 patients (8.4%), grade II in 25 patients (6.2%), grade III in 43 patients (10.6%), grade IV in 7 patients (1.7%) and grade V in 8 patients (2.0%). The highest incidence of complications was observed in left colon resection procedures (41.1%), open resections (39.8%), procedures lasting longer than 301 minutes (50%), patients older than 81 years (41.6%) and in procedures performed by the youngest, less experienced surgeon (40.6%). CONCLUSION: Our results confirmed that the type and approach of surgical procedure, patients age and surgeons experience are risk factors associated with a higher incidence of postoperative complications. High-risk surgical patients should be operated on by experienced surgeon who regularly performs a high number of resection procedures.

[Specialization in oncosurgery is not against the surgeons best interest]. / Specializace v onkochirurgii není proti zájmum chirurgu

An analysis of the current situation in the surgical treatment of solid malignant tumors in the Czech Republic demonstrates the need to impose a concept of oncosurgical care, which would lead to a steady improvement in the quality of care provided by surgeons in oncosurgery. The primary aim is that surgery plays an appropriate role in the complex care of oncology patients and that surgeons become equal partners to radiation and internal oncologists in the determination of diagnostic - therapeutic plans and in other decision-making processes. This aim is not possible without increasing the qualification of surgeons in oncosurgery. Our more than ten year effort culminated in 2011 with the introduction of the specialized field of oncosurgery into the postgradual education of surgeons; and as such, similarly to most other developed countries, provided the official opportunity to educate surgeons in the field of oncology. Other important tasks which would contribute to increasing the quality of oncosurgery include rational concentration of oncosurgical operations to a smaller number of surgical departments, where it is necessary to ensure both the improvement of surgeon qualification by way of oncosurgical specialization, as well as adequate material and financial support for complex oncosurgical procedures.

A role for resistin in the ovary during the estrous cycle.

In a previous study, we showed that resistin expression increased during ovarian follicle development in prepubertal pigs and had direct effects on steroidogenesis, suggesting an important role for resistin in the ovary during puberty. To determine its potential regulatory role in the ovary during the estrous cycle, using real-time PCR, immunoblotting, immunohistochemistry, and ELISA methods, we quantified the expression, immunolocalization and concentration of resistin in different sized ovarian follicles (small, 2-4 mm; medium, 4-6 mm; and large, 8-12 mm) in mature pigs. We then determined the effects of recombinant resistin (0.1, 1, and 10 ng/ml) on steroid hormone (progesterone-P4, androstendione-A4, testosterone-T, and estradiol-E2) secretion and steroidogenic enzyme (3ßHSD, CYP17A1, 17ßHSD, and CYP19A1) gene and protein expression in ovarian follicles. We found no differences in the resistin expression between all of the examined follicles. Immunostaining analysis also showed resistin expression in the cytoplasm of both granulosa and theca cells, where it was localized more abundantly in the granulosa cells compared to the theca cells. Recombinant resistin direct stimulated P4, A4, and T secretion via increased expression of 3ßHSD, CYP17A1, and 17ßHSD, suggesting an autocrine and/or paracrine regulatory role in the porcine ovary during the estrous cycle.

[Acceptable risks in surgery from the perspective of the evidence-based medicine and an evaluation of the quality of surgical care]. / Prípustná rizika v chirurgii z pohledu Medicíny zalozené na dukazech a hodnocení kvality chirurgické péce.

A qualified assessment of the risks of surgical treatment and especially operations is based on the evaluation of morbidity, mortality and long-term results of surgeons work. These analyses should be conducted based on the principles of the evidence-based medicine (EBM) and, in recent years, an assessment of the risks that surgical treatment has been included into a broader complex of evaluating the quality of surgical care. Surgery, other surgical specializations, and the urgent medicine belong among medical fields which most often carry a risk of unsuccessful outcomes and complications. Taking into account the complexity of medicine, the diagnostic and therapeutic processes are burdened necessarily by a certain number of complications. It is never possible to completely eliminate human errors, but what is possible is to continuously decrease their numbers and repair them on time. EBM is defined as a method of treating for patients based on the best scientific evidence resulting from clinical and epidemiological scientific research publications. From an EBM perspective, surgery compared with pharmaceutical treatment is usually at a disadvantage because the studies with the highest level of evidence (the controlled randomized studies) are usually not possible to be performed in surgery. In various situations it is only possible to obtain certain kinds of evidence and in surgery the highest level of evidence is most often obtained from cohort studies and case control studies as a possible means of sorting our information. Currently, evaluating the quality of surgical care should be in the forefront of interest of every surgeon. Traditional criteria include the evaluation of operative and postoperative complications, mortality, the number of re-operations, the evaluation of the satisfaction of the patient with the procedure performed, the length of survival of oncological patients, the number of recurrences and a number of other criteria. The term "High Volume Hospital" represents a newly developing concept of evaluating quality in surgery, which arises from the assumption that with the increasing number of procedures (operations) performed the quality of the results attained increases as well. The evaluation of quality in surgery is a topic which should be addressed more thoroughly among surgeons. The creation of indicators of quality of surgical care and their application into clinical practice has great significance for the development of surgery and it is not possible to leave it beyond the control of surgeons.

[Complications and risks of the surgery of tumors of the upper digestive tract (Foregut) Part I: Esophagus]. / Komplikace a rizika chirurgie nádoru horní cásti zazívacího traktu (Foregut) I. cást: Jícen.

INTRODUCTION: The aim of the work is to evaluate acceptable mortality and morbidity associated with the esophageal resections for carcinoma. METHOD: The work analyses the data of patients with esophageal cancer from the Czech National Cancer Registry and it compares personal experience with complications and risks associated with the esophagectomy for carcinoma with the data from specialized literature published in recent years. RESULTS: Despite improvements in the surgical technique and the perioperative intensive care, the esophagectomy maintains a relatively high morbidity and mortality. Published studies present mortality up to 10% and total morbidity between 40-60%. Respiratory complications are most frequent and significant and they reach up to 40% and the anastomotic dehiscence ranges from 0 to 25%. At the authors workplace in Nový Jicín, a total of 193 patients with the esophageal carcinoma were examined since 2007; 38% of these patients were indicated for operation and 62 esophageal resections with replacement were performed. The postoperative mortality within 30 days was 3.2% and the total morbidity was approximately 50%. Respiratory and cardiac complications were 28% and 18% respectively, fistula in the cervical anastomosis was seen in 5% and in the gastric tube in 3%, only one patient died from this surgical complication. The paralysis of the recurrent nerve occurred in 10%, and chylothorax in 3%. In almost all patients, the operation began with a laparoscopic revision to confirm operability and in 37% of the operated patients a video-assisted approach was used, most often the thoracoscopic mobilization of the esophagus. CONCLUSION: The surgical treatment of tumors of the esophagus is a highly specialized domain of thoracic surgeons specialized in the issuesof the esophagus. General trends for improving the morbidity and mortality include the use of minimally-invasive approaches, fast-track programs after the esophagectomy, and the application of principles of High-volume centres. The long-term prognosis of patients with esophageal cancer is principally dependent on the degree of advancement of the disease.

[Complications and risks in the surgery of tumors of the upper digestive tract (Foregut) Part II : Stomach]. / Komplikace a rizika chirurgie nádoru horní cásti zazívacího traktu (Foregut) II. cást: Zaludek.

INTRODUCTION: The aim of the work is to evaluate acceptable mortality and morbidity associated with stomach resections for carcinoma. METHOD: The work analyzes data of patients with gastric cancer from the Czech National Cancer Registry and compares personal experience with complications and risks associated with stomach resections for carcinoma with the data from specialized literature from recent years. RESULTS: The incidence of gastric cancer in the Czech Republic is presently 15.1/100 000 inhabitants, the mortality 11.6 and the prevalence 48.3. Stomach resections for carcinoma are complicated operations. Despite improving surgical techniques and tactics, as well as the perioperative intensive care, this procedure remains associated with significant morbidity and mortality. At the Department of Surgery of the Oncological Center and Hospital Nový Jicín, 286 patients with gastric cancer were operated between the years 2005 and 2012. In the group of 172 radical R0 resections, the mortality was 3.5% and the total morbidity was 33.7%. The most frequent and significant postoperative surgical complications were the pancreatitis (4.7%) and the anastomotic dehiscence (3.5%). The most frequent non-surgical ones were respiratory complications (4.7%). The mortality and morbidity frequency is comparable with the data published in specialized literature. Surgical treatment also utilized laparoscopy. All operations began with a diagnostic laparoscopy to specify the stage of the disease and to select the laparoscopic approach, most often a laparoscopically-assisted resection, which was used in 60 patients (30%). Laparoscopy was preferred even for the palliative anastomoses. No significant differences in morbidity and mortality were seen between open and laparoscopic procedures and statistical analysis is planned to gain greater experience. CONCLUSION: In the Czech Republic, surgical treatment of tumors of the stomach is currently performed at a large number of workplaces with a low frequency. General trends for improving the morbidity and mortality include the use of minimally-invasive approaches, a fast-track program, and the application of principles of High-volume centres. The long-term prognosis of patients with gastric cancer is principally dependent on the degree of advancement of the disease.

Elevated level of 17ß-estradiol is associated with overexpression of FSHR, CYP19A1, and CTNNB1 genes in porcine ovarian follicles after prenatal and neonatal flutamide exposure.

Recent studies suggest that disturbed androgen action during gestational and neonatal periods leads to reprogramming of the trajectory of ovarian development, manifested by altered follicular functioning in adulthood. In this study, we tested whether prenatal and neonatal exposure to antiandrogen flutamide affected ovarian 17ß-estradiol (E(2)) synthesis and the associated gene expression in large antral follicles of adult pigs. Flutamide was injected into pregnant gilts between Days 80 and 88 of gestation and into female piglets between Days 2 and 10 postnatally. After animals reached sexual maturity, the ovaries were collected from treated and nontreated (control) pigs. The analysis of E(2) concentration in follicular tissues, as well as FSH and LH levels in plasma of control and flutamide-treated animals were conducted. In addition, the expression of mRNAs and proteins for FSH receptor (FSHR), cytochrome P450 aromatase (CYP19A1) and ß-catenin (CTNNB1) was examined in large antral follicles of adult pigs. The E(2) concentration was greater in response to flutamide administered prenatally (P < 0.05) and neonatally (P < 0.01), whereas there was no changes in plasma gonadotropin concentration. Real-time polymerase chain reaction analysis revealed significant upregulation of FSHR, CYP19A1, and CTNNB1 at the mRNA level after maternal (P < 0.001, P < 0.01, P < 0.05, respectively) and neonatal (P < 0.001, P < 0.001, P < 0.01, respectively) flutamide exposure. The expression of FSHR protein was higher (P < 0.01) only after neonatal exposure to flutamide, whereas CYP19A1 and CTNNB1 proteins were upregulated in response to both prenatal (P < 0.01) and neonatal (P < 0.001) flutamide administration. Furthermore, membranous CTNNB1 immunolocalization indicates that it is not involved in regulation of FSH-mediated CYP19A1 activity as a transcription factor, but rather contributes to the intercellular adhesion. Concluding, it appears that the higher E(2) level in response to flutamide treatments is a result of the intensified aromatization and local E(2) action at the ovary level. The observed changes might influence the normal follicle development and pig fertility as a consequence.