Prophylactic surgical mesh placement as a prevention of parastomal hernia in open radical cystectomy with ileal conduit diversion - pilot study.

INTRODUCTION: This study examines the efficacy of prophylactic mesh implantation during open radical cystectomy with ileal conduit diversion in preventing parastomal hernias (PH). Despite PH being a common complication, prophylactic methods have been underexplored. METHODS: A pilot, single-center, prospective cohort study was conducted involving five patients undergoing surgery with mesh implantation. Demographic and clinical characteristics were monitored, including the incidence of PH, operation time, blood loss, and hospitalization duration. RESULTS: During the mean follow-up period of 9.1±3.2 months post-operation, no occurrences of PH were observed in the patient group. Despite the risks associated with implanting foreign material in an area of surgery involving open small intestine, no infectious complications were noted. CONCLUSION: Prophylactic mesh implantation in radical cystectomy with ileal conduit diversion appears to be an effective preventive measure against PH. Further extensive studies are required to definitively confirm the efficacy and safety of mesh use in this context.

Echocardiography predictors of sustained sinus rhythm after cardioversion of supraventricular arrhythmia in patients with septic shock.

PURPOSE: The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). MATERIALS AND METHODS: Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LV˃̳35%) and on a continuous noradrenaline of <1.0 µg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. RESULTS: Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8-15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,p˂0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(˃3) recurrences. CONCLUSION: The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.

Does the slope and length of the plantar calcaneal spur affect the clinic?

Since some of the patients with plantar calcaneal spur (PCS) do not have pain, we aimed to investigate the effect of the slope and length of the spur on this situation. The length and slope of PCS were measured by examining the radiological images of 50 patients in this prospective study. VAS, AOFAS and FFI scores of the patients were determined. Patients were divided into groups according to PCS length and slope. According to the slope of the spur, the mean AOFAS, FFI and VAS scores were, respectively; 94, 38, 1.3 in below 20 degrees; 80.1, 86.8, 4.8 in 20-30 degrees; and 70.1, 106, 6.7 in above 30 degrees. According to the length of the spur, the mean AOFAS, FFI and VAS scores were respectively; 84.9, 68.2, 3.7 in those with length 0-5 mm; 81.1, 81.7, 4.5 in those with a length of 5-10 mm; and 71.7, 102.5, 6.4 in those with a length of >10 mm. A significant correlation was found between the angle and length of the PCS with the values of VAS, AOFAS and FFI (p<0.05). We observed that PCSs with a slope of less than 30 degrees and shorter than 10 mm do not create a serious clinical picture. If there is severe pain and functional impairment in individuals with this characteristic spur, investigation of other possible causes of heel pain must be considered.

Native nephrectomy in patients with autosomal dominant polycystic kidney disease in the kidney transplant program - single-center retrospective results of 2000-2020.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disease that leads to chronic renal failure in about half of patients. It is a multisystemic disease with a predominance of kidney involvement, which significantly worsens the patient's health. Controversial issues include the indication and the timing and technique of nephrectomy of native polycystic kidneys. METHODS: A retrospective observational study focused on the surgical aspects of patients with ADPKD who underwent native nephrectomy at our institution. The group included patients operated on in the period 1/1/2000-31/12/2020. A total of 115 patients with ADPKD were enrolled (14.7% of all transplant recipients). We evaluated the basic demographic data, type of surgery, indications and complications in this group. RESULTS: Native nephrectomy was performed in 68 out of a total of 115 (59%) patients. Unilateral nephrectomy was done in 22 (32%) patients and bilateral in 46 (68%). The most common indications were infections (42 patients, 36%), pain (31 patients, 27%), hematuria (14 patients, 12%), gastrointestinal reasons (1 patient, 1%), respiratory reasons (1 patient, 1%), obtaining a site for transplantation (17 patients, 15%) and suspected tumor (5 patients, 4%). CONCLUSION: Native nephrectomy is recommended in symptomatic kidneys, or in asymptomatic kidneys when it is necessary to obtain a place for kidney transplantation, and in kidneys where a tumor is suspected.

The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox.

PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

Can the prophylactic administration of tranexamic acid reduce the blood loss after robotic-assisted radical prostatectomy? Robotic Assisted Radical Prostatectomy with tranEXamic acid (RARPEX): study protocol for a randomized controlled trial.

BACKGROUND: The prophylactic administration of tranexamic acid reduces blood loss during procedures at high risk of perioperative bleeding. Several studies in cardiac surgery and orthopedics confirmed this finding. The aim of this prospective, double-blind, randomized study is to evaluate the effect of tranexamic acid on peri-and postoperative blood loss and on the incidence and severity of complications. METHODS/DESIGN: Based on the results of our pilot study, we decided to conduct this prospective, double-blind, randomized trial to confirm the preliminary data. The primary endpoint is to analyze the effect of tranexamic acid on perioperative and postoperative blood loss (decrease in hemoglobin levels) in robotic-assisted radical prostatectomy. The additional endpoint is to analyze the effect of tranexamic acid on postoperative complications and confirm the safety of tranexamic acid in robotic-assisted radical prostatectomy. DISCUSSION: No study to date has tested the prophylactic administration of tranexamic acid at the beginning of robotic-assisted radical prostatectomy. This study is designed to answer the question of whether the administration of tranexamic acid might lower the blood loss after the procedure or increase the rate and severity of complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT04319614. Registered on 25 March 2020.

Structural characterization of polysaccharides from Geranium sanguineum L. and their immunomodulatory effects in response to inflammatory agents.

ETHNOPHARMACOLOGICAL RELEVANCE: Geranium sanguineum L. is used for treatment of inflammations, anemia, malignant diseases of the blood-forming organs, diarrhea, respiratory infections, etc. Only flavonoids in root extracts have been elucidated as immunostimulating and anti-inflammatory compounds, and polysaccharides in the herb have not been examined. AIM OF THE STUDY: to compare the chemical features of polysaccharide complexes (PSCs) from leaves (GSL-PSC) and roots (GSR-PSC) of G. sanguineum, as well as their immunomodulatory activities on leukocytes after inflammation, and effects on the growth of different bacteria. MATERIALS AND METHODS: The samples were isolated by water extraction and their structural features were studied by 2D NMR spectroscopy. The stimulatory effects of both PSCs on human leukocytes were analyzed with flow cytometry. Their suppressive activities on the oxidative burst in blood and derived neutrophils against opsonized zymosan and phorbol myristate acetate were investigated. The effects of the samples on viability, NO and interleukin 6 (IL-6) syntheses in RAW264.7 cells after inflammation with lipopolysaccharides (LPS) were tested. The prebiotic and anti-biofilm activities of the PSCs were evaluated. RESULTS: The total carbohydrate content in the samples was significant (73.6-76.8%). GSL-PSC contained pectins, which were rich in homogalacturonan (HG), and smaller amounts of rhamnogalacturonan (RG) type I, decorated by 1,5-α-L-Araf, 1,4- and 1,6-ß-D-Galp chains. GSR-PSC contained starch, followed by pectins with lower HG content and more RG-I regions, substituted by 1 â†’ 3,5-α-L-arabinans and 1 â†’ 3,6-ß-D-galactans. GSL-PSC and GSR-PSC (200 µg/mL) increased monocyte and granulocyte cell counts, but GSR-PSC also elevated T helper and B cell levels in a normal and activated state. GSR-PSC triggered a dose-dependent (50-200 µg/mL) oxidative burst in blood, but alleviated it after inflammation even in blood-derived neutrophils. It was free of LPS, and activated NO and IL-6 productions in RAW264.7 cells better than GSL-PSC, without affecting their viability. Both PSCs (2.0%, w/v) stimulated probiotic co-cultures between Clostridium beijerinckii strains and Lactobacillus sp. ZK9, and inhibited the growth and biofilm formation of Escherichia coli, Streptococcus mutans and Salmonella enterica. CONCLUSIONS: The PSs in G. sanguineum could be involved in the stimulatory effects on blood-forming organs and anti-inflammatory action of aqueous root extracts in case of infections. These PSs should be included in synbiotic foods to support the treatment of inflammations and infections in the gut.

Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel.

BACKGROUND: The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. METHODS: We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other "topic-specific" items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. RESULTS: From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. CONCLUSION: This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.

Tilia tomentosa pectins exhibit dual mode of action on phagocytes as ß-glucuronic acid monomers are abundant in their rhamnogalacturonans I.

Silver linden flowers contain different pectins (PSI-PSIII) with immunomodulating properties. PSI is a low-esterified pectic polysaccharide with predominant homogalacturonan region, followed by rhamnogalacturonan I (RGI) with arabinogalactan II and RGII (traces) domains. PSII and PSIII are unusual glucuronidated RGI polymers. PSIII is a unique high molecular weight RGI, having almost completely O-3 glucuronidated GalA units with >30% O-3 acetylation at the Rha units. Linden pectins induced reactive oxygen species (ROS) and NO generation from non-stimulated whole blood phagocytes and macrophages, resp., but suppressed OZP-(opsonized zymosan particles)-activated ROS generation, LPS-induced iNOS expression and NO production. This dual mode of action suggests their anti-inflammatory activity, which is known for silver linden extracts. PSI expressed the highest complement fixation and macrophage-stimulating activities and was active on intestinal Peyer's patch cells. PSIII was active on non-stimulated neutrophils, as it induced ß2-integrin expression, revealing that acetylated and highly glucuronidated RGI exhibits immunomodulating properties via phagocytes.

Acidic polysaccharide complexes from purslane, silver linden and lavender stimulate Peyer's patch immune cells through innate and adaptive mechanisms.

Three polysaccharide complexes (PSCs) were isolated from the aerial parts of common purslane (Portulaca oleracea L.), and the flowers of common lavender (Lavandula angustifolia Mill.) and silver linden (Tilia tomentosa Moench) by boiling water extraction and ethanol precipitation. The chemical composition and immunomodulating effects of isolated PSCs were characterized. The chemical characterization revealed that the three samples contain mainly pectic polysaccharides. They exhibited ex vivo intestinal immunomodulating activity through the murine Peyer's patch-mediated bone marrow cell proliferation test at 100µg/ml concentration. At the same time, they stimulated ex vivo human blood T-cell populations (CD4+/CD25+ and CD8+/CD25+), phagocytic leukocytes (CD14+ and CD64+ cells) and induced IL-6 production from human white blood cells and Peyer's patch cells. The herbal PSCs stimulated ex vivo ROS production from whole blood phagocytes and showed unspecific in vitro anti-proliferative activity against normal and A549, HeLa and LS180 tumor cells. This is the first report on immunomodulating studies of linden flower pectins and chemical and biological activity characterization of lavender polysaccharides. Our study demonstrates that similarly to purslane, lavender and silver linden herbal materials contain immunomodulating polysaccharides that could be useful for support of compromised immune system.

Propafenone for supraventricular arrhythmias in septic shock-Comparison to amiodarone and metoprolol.

PURPOSE: The occurence of supraventricular arrhythmias associate with an unfavourable prognosis in septic shock. Propafenone could be a feasible antiarrhythmic. MATERIALS AND METHODS: Patients collected over a period of 24months were divided into the three groups based on antiarrhythmic: Group1(amiodarone), Group2(propafenone), Group3(metoprolol). Type of arrhythmia, cardioversion rates, demographic, haemodynamic, laboratory parameters were recorded in the first 24h. The outcome data were compared between the groups. RESULTS: 234 patients (99.1% ventilated) were included, the prevailing arrhythmia was acute onset atrial fibrillation (AF,69.7%). Except for the dosage of noradrenaline (0.35(0.14-0.78) in Group1(n=142)vs 0.25(0.10-0.50),p<0.01 in Group2(n=78)vs 0.14(0.07-0.25)µg/kg·min,p<0.05 in Group3(n=14)) the ejection fraction of left ventricle, rates of renal replacement therapy, arterial lactate and procalcitonin levels were not different between the groups. The cardioversion rate in Group1(74%) was lower than in Group2(89%) and Group3(92%). ICU and 28-day mortalities of Group1 were not significantly higher than in Group2 and Group3. Multivariate analysis demonstrated higher 12-month mortality in Group1 than in Group2 (HR1.58(1.04;2.38),p=0.03). CONCLUSIONS: Propafenone demonstrated a higher cardioversion rate than amiodarone with a similar impact on the outcome. Patients remaining in acute onset arrhythmia did not demonstrate significantly higher ICU, 28-day and 12-month mortalities compared to those successfully cardioverted or to those having chronic AF.

The ICM research agenda on critical care ultrasonography.

PURPOSE: Critical care ultrasonography has utility for the diagnosis and management of critical illness and is in widespread use by frontline intensivists. As there is a need for research to validate and extend its utility, the Editor of Intensive Care Medicine included critical care ultrasonography as a topic in the ICM Research Agenda issue. METHODS: Eleven international experts in the field of critical care ultrasonography contributed to the writing project. With the intention of developing a research agenda for the field, they reviewed best standards of care, new advances in the field, common beliefs that have been contradicted by recent trials, and unanswered questions related to critical care ultrasonography. RESULTS: The writing group focused on the provision of training in critical care ultrasonography, technological advances, and some specific clinical applications. CONCLUSIONS: The writing group identified several fields of interest for research and proposed ten research studies that would address important aspects of critical care ultrasonography.

Evaluation of the Quality of Life and Psychiatric Symptoms of Patients with Primary Coxarthrosis after Total Hip Arthroplasty.

PURPOSE OF THE STUDY In this study, it was aimed to examine the preoperative and postoperative quality of life and psychiatric symptoms of the patients with primary coxarthrosis after total hip arthroplasty. MATERIAL AND METHODS 150 patients undergone total hip arthroplasty were involved in this study. The socio-demographical data form prepared by the researchers was utilized before and after the operation in order to demonstrate disease-related socio-demographical characteristics of the patient. The Quality of Life Scale Short Form (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Harris Hip Score (HHS) and Visual Analog Scale (VSA) were implemented in the preoperative period and at 6th and 12th week after the operation. RESULTS Of the patients involved in study, 28.7% were male and 71.3% were female. Their mean age was 58.34±11.92 year. While statistically significant differences were found between the preoperative and postoperative periods in terms of physical function, physical role limitation, emotional role limitation, energy, social function, pain, and general health subscales of SF-36, no significant differences were found relating mental health subscale. In BAI, BDI, VAS, and HHS comparison, statistically significant differences were found between the preoperative and postoperative periods, except for BAI. CONCLUSIONS In this study, it was determined that primary coxarthrosis affects significantly the quality of the patients' lives in a negative way and can be accompanied by mental symptoms. After total hip arthroplasty, significant improvement was observed in quality of life, depression and pain scores. Key words: total hip prosthesis, quality of life, mental symptoms.

Protective effects of thymoquinone and alpha-tocopherol on the sciatic nerve and femoral muscle due to lower limb ischemia-reperfusion injury.

OBJECTIVE: Thymoquinone (TQ) is an antioxidant and anti-apoptotic substance found in the Nigella sativa plant. Alpha-tocopherol (α-TP) is a potent antioxidant. We aimed to determine whether or not TQ and TP have a protective effect against lower limb ischemia-reperfusion (IR) injury of muscle and the sciatic nerve. MATERIALS AND METHODS: A single dose of TQ 25 mg/kg was given intraperitoneally to the TQ group, a single dose of α-TP 200 mg/kg was given intraperitoneally to the α-TP group. IR was performed for 45 minutes after the drugs' applications. RESULTS: While serum levels of malondialdehyde (MDA) and interleukin-6 (IL-6) of the IR group were significantly higher than those of the TQ plus α-TP, TQ and α-TP groups (p<0.001, p<0.001, p=0.008, respectively) and IL-6 (all p<0.001), the reduced glutathione (GSH) level of the IR group was lower than that of the other three groups. While neuronal nitric oxide synthase activity of nerve tissues of the IR group was significantly lower than that of the TQ plus α-TP group, the muscle tissue caspase-3 activity was higher than that of the TQ plus α-TP group. CONCLUSIONS: Administration of TQ plus α-TP may strongly protect muscle and nerve tissues against IR injury via their synergistic effects.

[Basic principles of diagnosis and treatment of secondary peritonitis - recommendations of experts with the support of SIS]. / Základní principy diagnostiky a lécby sekundární peritonitidy - doporucení odborníku s podporou SIS.

Secondary peritonitis is the most common cause of inflammatory acute abdomen treated at general surgery departments. Only early and correct diagnosis may improve the prognosis of these patients. The authors compiled an interdisciplinary review of the basic principles of diagnosis and treatment of secondary peritonitis, which reflects current findings supported by evidence-based medicine. The work is based on published international literature but also shares opinions and experiences of the selected specialists. The presented work in its extent is not meant to substitute an in-depth study of the issue, but to allow a basic and quick review of the topic.

Extracorporeal membrane oxygenation used in a massive lung bleeding following pulmonary endarterectomy.

The authors present a case of massive lung bleeding following pulmonary endarterectomy (PEA) that was treated with peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO). The patient repeatedly underwent bronchoscopy for airway blood clot obstruction and finally was successfully weaned off the support. The authors discuss the indications for ECMO in treatment of the most serious complications following PEA, and emphasize the importance of echocardiographic evaluation of the right ventricular function in relation to the indicated type of extracorporeal support. Anticoagulation strategy for patients shortly after the major surgery connected to ECMO is also discussed.

[Peripartal life-threatening hemorrhage - interdisciplinary consensus opinion]. / Peripartální zivot ohrozující krvácení - mezioborové konsenzuální stanovisko.

22 experts from the fields of gynecology and obstetrics, anesthesiology and resuscitation, intensive care, hematology and transfusion medicine has developed recommendations for diagnosis and procedure for life-threatening peripartum haemorrhage, which is still one of the most common causes of maternal mortality in childbirth. This guidelines, which is valid for the Czech Republic, supported by a total of 10 professional medical societies. There are based on new knowledge applicable at this time and is focused mainly on eliminating the most common causes of bleeding during delivery and prevention of haemorrhagic shock.

A review of a newly established ECMO program in a university affiliated cardiac center.

Extracorporeal membrane oxygenation (ECMO) is an established rescue treatment option for severe respiratory and cardiac failure in infants and neonates and has recently become widely utilised in adults. ECMO support can be initiated rapidly in an emergency setting both by percutanous implantation and surgically; it allows transportation of patients in cardio-pulmonary collapse and bridging of critically ill patients to be recovered, other support measures or transplantation. The aim of this study was to report authors' initial experience after starting an ECMO program in a university-based cardiac center. The institutionally approved ECMO team bears responsibility for adjudication regarding indication and implementation of ECMO in all patients. Since the establishment of the ECMO team in October 2007, one elective and nine urgent patients in deep cardiogenic and/or ventilatory collapse were treated by ECMO support up to December 2008. Three patients suffered severe acute right heart dysfunction, two patients suffered postcardiotomy refractory cardiogenic shock, two patients had a cardiogenic shock due to postinfarction interventricular septal rupture, two patients experienced severe respiratory failure and one had elective ECMO implantation as a back-up support during high-risk percutaneous coronary intervention. Veno-arterial ECMO was used in eight cases and veno-venous in two cases of isolated respiratory failure. In nine patients, ECMO circuit was instituted by peripheral cannulation, in eight out of nine cases by percutaneous puncture. On one occasion central surgical cannulation was used. In urgent patients, immediate hemodynamic and oxygenation improvement was observed. Average support duration was 6.8 days (range 1-16 days). Five (50 %) patients were successfully weaned from ECMO and survived to hospital discharge. The illness severity in urgent patients defined by SOFA score ranged from 10 to 17, patients dying while on ECMO had higher SOFA scores (14.8±1.6 vs. 10.8±1.5; P=0.0065). Complications included mainly bleeding. ECMO support allows treatment of severely ill patients in imminent cardiovascular and/or ventilatory collapse. Therefore, establishment of an ECMO program in university affiliated cardiac center is fully justified. A multidisciplinary approach is essential. Despite adequate training and education of ECMO team members, this highly invasive therapeutic modality bears an inherent risk of complications.