The experience with colorectal cancer screening in the Czech Republic: the detection at earlier stages and improved clinical outcomes.

OBJECTIVES: Colorectal cancer (CRC) remains a major health burden. Although screening is recommended and considered beneficial, further data on its positive effects are needed for worldwide implementation. STUDY DESIGN: The aim of our national multicentre prospective observational study was to reveal and document clinicopathological differences in CRC diagnosed by screening and presented by disease symptoms as well as assess the efficiency of the screening programme in the Czech Republic. METHODS: Between March 2013 and September 2015, a total of 265 patients were enrolled in 12 gastroenterology centres across the Czech Republic. Patients were divided into screening and symptomatic groups and compared for pathology status and clinical characteristics. Screening was defined as a primary screening colonoscopy or a colonoscopy after a positive faecal occult blood test in an average-risk population. RESULTS: The distribution of CRC stages was significantly (statistically and clinically) favourable in the screening group (predominance of stages 0, I and II) compared with the non-screening group (P < 0.001). The presence of distant and local metastases was significantly less frequent in the screening group than in the symptomatic group (P < 0.001). Patients in the screening group had a higher probability of radical surgery (R0) than those diagnosed based on symptoms (P < 0.001). Systemic palliative treatment was indicated in two patients in the screening group compared with 23 patients in the non-screening group (P = 0.018). CONCLUSION: CRC diagnosed by screening disclosed less advanced clinicopathological characteristics and results in patients with a higher probability of radical surgery (R0) than diagnoses established based on symptoms, with subsequent management differing accordingly between both groups. These results advocate the implementation of a suitable worldwide screening programme.

Fixation of biomaterial to metallic stent and fixation of stents after circular endoscopic dissection in the esophagus on an animal model.

INTRODUCTION: Complete circular endoscopic (submucosal) resection (CER) performed using the endoscopic submucosal dissection (ESD) technique is burdened with a high incidence of post-operative strictures in the esophagus. The most effective method of preventing them is not known so far; one of the possible methods is to prevent these strictures directly at the site of their formation by covering the defect with a stent. The aim of the study was to find a way to fix a selected biomaterial to a stent, and subsequently, to fix the stent at the CER site to prevent esophageal strictures in an animal model. METHOD: Miniature piglets from the Czech Academy of Sciences breeding unit in Libechov (N=10) were used. Endoscopy was performed using a single-channel endoscope. First, we made two circular mucosal cuts spaced 5 cm apart in the middle esophagus and we performed the CER between them using the endoscopic submucosal dissection technique. After that, we covered the defect with a stent coated with biomaterial (Xe-Derma®) while we tried to prevent stent migration into the stomach. For stent fixation, we tested endo-clips (N=3), the Apollo endoscopic system (N=1) and the suspension technique using two polyamide threads (N=6) anchored in the nasal septum. We performed a control endoscopy, stent removal and subsequent autopsy after 12 weeks. RESULTS: All procedures were completed successfully without serious complications or deaths. Although stents covered with Xe-Derma® were applied to the entire resection area, one case of mediastinitis and one paraesophageal abscess were found during autopsy, most likely due to microperforations caused during the procedure. Histological analysis showed that after contact with the biomaterial, re-epithelisation took place within one week of application to the resection area. Stent migration occurred in each case when the stent was attached to the esophageal wall by endo-clips or with the endoscopic suture system (Apollo). There was no stent dislocation in the cases where the stent was suspended by two polyamide threads. CONCLUSION: We developed a technique of fixing biomaterial to the surface of metallic stents which we used to prevent the formation of esophageal strictures after CER. Distal suspension fixation of the stent with a polyamide thread proved to be the most effective, while fixations by endo-clips or with the endoscopic suture system were ineffective.Key words: benign esophageal strictures circular endoscopic resection endoscopic submucosal dissection complication prevention.

[Molecular Pathogenesis of Colorectal Cancer]. / Molekulární genetika kolorektálního karcinomu.

BACKGROUND: Colorectal cancer (CRC) remains a major health burden with an incidence of 1.3 million new cases worldwide and a mortality of almost 8.5%. It is the 2nd most common cancer in women (1st breast carcinoma) and 3rd most common in men (1st lung carcinoma, 2nd prostate carcinoma). CRC alongside breast, lung, prostate and stomach cancer is in the top five most common cancers in men and women worldwide. There are still more than 50% of CRC patients diagnosed with advanced disease (stage III and IV) in the Czech Republic. Genetically, CRC is a very heterogeneous disease with many factors playing key roles in pathogenesis. There are two types of CRC, hereditary with an incidence of between 5% and 10% with APC (FAP, aFAP) or MMR (HNPCC) genes affected, and sporadic colorectal cancer with an incidence of 90-95% with a lot of mutations in variable genes that accumulate during pathogenesis (APC, KRAS, MMR, microRNA, CIMP etc.). Knowledge of the molecular pathogenesis of CRC (hereditary, sporadic) is crucial for treatment, assessment of risk, prognosis, and patient follow-up. CONCLUSION: This article summarizes the molecular pathogenesis of sporadic and hereditary CRC.

'Obesity paradox' misunderstands the biology of optimal weight throughout the life cycle.

The 'obesity paradox' refers to observations that run counter to the thesis that normal weight (BMI 18.5-24.9 g/m(2)) provides the lowest mortality and higher weight is associated with greater mortality. We argue that the weight of lowest mortality is influenced by aging and chronic disease, with mortality advantage extending into the overweight and even class I obese ranges under some circumstances. A focus on quality nutrition, physical activity, fitness, and maintaining function in these weight ranges may be preferable to a focus on intentional weight loss, which has uncertain effects. The 'obesity paradox' is no 'paradox' if one defines and interprets 'ideal' weight appropriately.

Sex chromosome pairing and extensive NOR polymorphism in Wadicosa fidelis (Araneae: Lycosidae).

In terms of cytogenetics, entelegyne araneomorphs are the best studied clade of spiders. The typical karyotype of entelegyne males consists of acrocentric chromosomes, including 2 non-homologous X chromosomes. The present study is focused on the karyotype, nucleolus organising regions (NORs) and sex chromosome behaviour during meiosis of the entelegyne Wadicosa fidelis (Lycosidae). Preparations stained by Giemsa were used to study karyotype and meiosis. NORs were visualised by silver staining and fluorescence in situ hybridisation with 18S rDNA probe. The male karyotype consists of 28 acrocentric elements, including 2 X chromosomes. In contrast to the majority of other spiders, the male sex chromosomes pair during the major part of meiosis. Following an initial period of parallel pairing, the attachment of male sex chromosomes is restricted to centromeric areas and continues until metaphase II. Our study revealed an enormous number of NORs in the population from Galilee and indicates a considerable variability of NOR numbers in this population. The distal regions of 9 or 10 autosomal pairs contain NORs. The obtained data indicate the rapid spread of NORs in the karyotype of W. fidelis, which was presumably caused by ectopic recombinations and subsequent hybridisations of individuals with different NOR genotypes that produced heterozygotes.

Microdialysis in early detection of temporary pancreatic ischemia in a porcine model.

BACKGROUND: Ischemic injury to the pancreas occurs in various clinical conditions. A method for online monitoring of pathophysiological events in pancreatic parenchyma is missing. AIMS: To assess the timing of microdialysis (MD) technique response on temporary changes in pancreatic perfusion, and to evaluate the relationship between MD data and systemic markers of anaerobic metabolism and inflammation. METHODS: In anaesthetized normoventilated pigs, MD probes were placed in right (control) and left (ischemic) pancreatic lobes, respectively. Following the clamping of the vessels, ischemia was verified by tissue oxygen tension (P(ti)O(2)) measurements. RESULTS: P(ti)O(2) decreased within 20 min after the clamping of the vessels, already returning to baseline levels at the first sampling point after the removal of the clamp. MD lactate levels increased, whereas pyruvate and glucose levels decreased at 20 min after the induction of ischemia. These trends continued until the end of ischemia and returned to baseline following reperfusion. Serum lactate, amylase and tumor necrosis factor-alpha levels decreased throughout the protocol time. CONCLUSION: MD data were in concordance with changes in P(ti)O(2), which is indicative of local anaerobic metabolism. MD allowed the detection of pathophysiological processes within the ischemic pancreas at a stage when no elevations of systemic markers of ischemia or inflammation were observed.

The first cytogenetic characterization of atemnids: pseudoscorpions with the highest chromosome numbers (Arachnida: Pseudoscorpiones).

The karyotypes of pseudoscorpions of the family Atemnidae (Arachnida: Pseudoscorpiones) were studied for the first time. Karyotype data for 7 species have been obtained. The diploid chromosome numbers of most species considerably exceed the numbers reported in pseudoscorpions so far, with males ranging between 65 and 143. In spite of this, the sex chromosome system of atemnids is characterized by the same features that are found in the majority of other pseudoscorpions with an X0 system; the X chromosome is metacentric and is the largest chromosome or one of the largest chromosomes of the karyotype. Male meiotic cells of Atemnus politus contain 1 or 2 autosome multivalents; most specimens had 2 multivalents. The multivalents were composed of 4, 6, 8 or 10 chromosomes. Multivalent number and structure was consistent within each of the studied individuals. The same number of chromosomes in all of the males examined suggests that multivalents are generated by reciprocal translocations. The high diversity of multivalents suggests considerable range of translocation heterozygosity in the studied population.

[750 satisfied patients? Stapled haemorrhoidopexy (Longo procedure) for the treatment of haemorrhoids and anal canal prolapse: a review of our 10-year experience]. / 750 spokojených pacientu? 10 let zkuseností a výsledku Longovy metody operace hemoroidu a análních prolapsu.

INTRODUCTION: Haemorrhoid disease in a common ailment, which constitues a serious clinical and social problems, especially in countries having a significant level of development. There have been a great number of articles published on the method of treatment for haemorrhoid disease and anal canal prolapse with circular stapler introduced to clinical practise by Longo in the year 1993. However, there are very few studies devoted to assessment of this procedure in the Czech medical literature. AIM: Summary our 10 year experience--to perform a retrospective evaluation of early and long-term results of surgical treatment with a Longo procedure. PATIENTS AND METHODS: We evaluated retrospectively 750 patients, submitted in our hospital to Longo procedure since January 2000 until December 2009, considering results and complications of this procedure. 435 (58%) were women and 315 (42%) men, aged from 17 to 83 (46.2 years old on overall). Mean follow up was 5.5 months (ranged from 3 months to 3.5 years). RESULTS: Complications occurred in 76 patients (10.1%). In 24 patients (3.2%) during the early post-operative period. Late complications developed in 52 patients (6.9%). 34 patients (4.5%) required reoperation. Duration of hospitalisation after the procedure ranged from 2 to 8 days, an overage of 3.2 days. CONCLUSION: Longo procedure in indicated cases--treatment of the 3rd and 4th stage of haemorrhoid disease and anal canal prolapse, is an advisable alternative to other surgical methods. Has satisfactory short and long-term effects, lower postoperative pains, shortening of the patient's hospital stay. Longo's method is safe and suitable for the haemorrhoid therapy, can be recommended in selective patients for a one-day surgery scheme.

Insights into the meiotic behavior and evolution of multiple sex chromosome systems in spiders.

A characteristic feature of spider karyotypes is the predominance of unusual multiple X chromosomes. To elucidate the evolution of spider sex chromosomes, their meiotic behavior was analyzed in 2 major clades of opisthothele spiders, namely, the entelegyne araneomorphs and the mygalomorphs. Our data support the predominance of X(1)X(2)0 systems in entelegynes, while rare X(1)X(2)X(3)X(4)0 systems were revealed in the tuberculote mygalomorphs. The spider species studied exhibited a considerable diversity of achiasmate sex chromosome pairing in male meiosis. The end-to-end pairing of sex chromosomes found in mygalomorphs was gradually replaced by the parallel attachment of sex chromosomes in entelegynes. The observed association of male X univalents with a centrosome at the first meiotic division may ensure the univalents' segregation. Spider meiotic sex chromosomes also showed other unique traits, namely, association with a chromosome pair in males and inactivation in females. Analysis of these traits supports the hypothesis that the multiple X chromosomes of spiders originated by duplications. In contrast to the homogametic sex of other animals, the homologous sex chromosomes of spider females were already paired at premeiotic interphase and were inactivated until prophase I. Furthermore, the sex chromosome pairs exhibited an end-to-end association during these stages. We suggest that the specific behavior of the female sex chromosomes may have evolved to avoid the negative effects of duplicated X chromosomes on female meiosis. The chromosome ends that ensure the association of sex chromosome pairs during meiosis may contain information for discriminating between homologous and homeologous X chromosomes and thus act to promote homologous pairing. The meiotic behavior of 4 X chromosome pairs in mygalomorph females, namely, the formation of 2 associations, each composed of 2 pairs with similar structure, suggests that the mygalomorph X(1)X(2)X(3)X(4)0 system originated by the duplication of the X(1)X(2)0 system via nondisjunctions or polyploidization.

[The role of echocardiography in cardiovascular diseases assessment during pregnancy]. / Význam echokardiografie v diagnostice kardiovaskulárních onemocnení u tehotných zen.

Maternal heart disease complicates at least 1% of pregnancies and is one of the most important causes of maternal death. Echocardiographic examination provides valuable information about the size and function of cardiac chambers, valve morphology and function, hemodynamic consequences of various cardiac pathologies. It is particularly important during pregnancy when the complaints and physical signs may be misleading. Echocardiography is well suited to rapid diagnosis in pregnant women with known or suspected cardiac disorders. This review article deals with the contribution of echocardiography to precise diagnosis and management of cardiovascular diseases in pregnancy.

Effects of maternal surgical weight loss in mothers on intergenerational transmission of obesity.

BACKGROUND AND OBJECTIVES: By studying cardiometabolic risk factors in children born after maternal biliopancreatic diversion bariatric surgery (AMS) compared with those in children born before maternal surgery (BMS), we tested the hypothesis that significant maternal weight loss may modify obesity-related factors transmitted via the intrauterine environment. DESIGN: Anthropometry and fasting blood levels were studied in 49 mothers who had lost 36 +/- 1.8% body weight sustained for 12 +/- 0.8 yr and their 111 children (54 BMS and 57 AMS) aged 2.5-26 yr. RESULTS: AMS children had lower birth weight (2.9 +/- 0.1 AMS vs. 3.3 +/- 0.1 kg BMS, P = 0.003) associated with a reduced prevalence of macrosomia (1.8 AMS vs. 14.8% BMS, P = 0.03) with no difference in underweight. At the time of follow-up, AMS children exhibited 3-fold lower prevalence of severe obesity (11 vs. 35%, P = 0.004), greater insulin sensitivity (homeostasis model assessment of insulin resistance index 3.4 +/- 0.3 vs. 4.8 +/- 0.5, P = 0.02), improved lipid profile (cholesterol/high-density lipoprotein cholesterol 2.96 +/- 0.11 vs 3.40 +/- 0.18, P = 0.03; high-density lipoprotein cholesterol 1.50 +/- 0.05 vs. 1.35 +/- 0.05 mmol/liter, P = 0.04), lower C-reactive protein (0.88 +/- 0.17 vs. 2.00 +/- 0.34 microg/ml, P = 0.004), and leptin (11.5 +/- 1.5 vs.19.7 +/- 2.5 ng/ml, P = 0.005) and increased ghrelin (1.28 +/- 0.06 vs.1.03 +/- 0.06 ng/ml, P = 0.005) than BMS offspring (AMS vs. BMS, respectively, for all). CONCLUSIONS: This unique study of children aged 2.5-26 yr born before and after maternal antiobesity surgery demonstrated improvements in cardiometabolic markers sustained into adolescence, attributable to an improved intrauterine environment.

[Stapled hemorrhoidopexy (Long method)--procedure for prolapsing hemorrhoids (PPH)--eight-year experience with the method]. / Longova metoda operace hemoroidu a prolapsu sliznice anorekta (PPH)--zkusenosti 8 let.

Based on the author's long-term experience with stapled hemorrhoidopexy (procedure for prolapsing hemorrhoids-PPH), principal pros and cons of the procedure are presented in the article. Stapled hemorrhoidopexy is considered an option for radical and safe management of advanced hemorrhoid disorders.

[Recurrent peripheral arterial embolism from metastatic lung choriocarcinoma]. / Opakované embolizace do periferních tepen z plicní metastázy choriokarcinomu.

A case of patient with choriocarcinoma, most likely of ovarian origin, with lung metastasis is presented. The disease manifested by recurrent embolism into peripheral arteries. Publications on this topic are reviewed.

Evidence-based medicine reports on obesity surgery: a critique.

OBJECTIVE: To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, 1978-2004. RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

Limits on the decay-rate difference of neutral B mesons and on CP, T, and CPT violation in B(0-0)B oscillations.

Using events in which one of two neutral B mesons from the decay of an Upsilon(4S) meson is fully reconstructed, we determine parameters governing decay (DeltaGamma(d)/Gamma(d)), CP, and T violation (|q/p|), and CP and CPT violation (Re z,Im z). The results, obtained from an analysis of 88 x 10(6) Upsilon(4S) decays recorded by BABAR, are sgn(Re lambda(CP))DeltaGamma(d)/Gamma(d)=-0.008+/-0.037(stat)+/-0.018(syst)[-0.084,0.068],|q/p|=1.029+/-0.013(stat)+/-0.011(syst)[1.001,1.057],(Re lambda(CP)/|lambda(CP)|) Re z=0.014+/-0.035(stat)+/-0.034(syst)[-0.072,0.101],Im z=0.038+/-0.029(stat)+/-0.025(syst)[-0.028,0.104]. The values inside the square brackets indicate the 90% confidence-level intervals. These results are consistent with standard model expectations.

Search for the radiative decays B-->rhogamma and B0-->omegagamma.

A search of the exclusive radiative decays B-->rho(770)gamma and B0-->omega(782)gamma is performed on a sample of about 84x10(6) BBmacr; events collected by the BABAR detector at the SLAC PEP-II asymmetric-energy e+e- storage ring. No significant signal is seen in any of the channels. We set upper limits on the branching fractions B of B(B0-->rho(0)gamma)<1.2 x 10(-6), B(B+-->rho+gamma)<2.1 x 10(-6), and B(B0-->omegagamma)<1.0 x 10(-6) at 90% confidence level (C.L.). Using the assumption that Gamma(B-->rhogamma)=Gamma(B+-->rho(+)gamma)=2 x Gamma(B0-->rho(0)gamma), we find the combined limit B(B-->rhogamma)<1.9 x 10(-6), corresponding to B(B-->rhogamma)/B(B-->K*gamma)<0.047 at 90% C.L.

Measurement of the branching fraction and polarization for the decay B--->D*0K*-.

We present a study of the decay B--->D(*0)K(*-) based on a sample of 86 x 10(6) Upsilon(4S)-->BBmacr; decays collected with the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC. We measure the branching fraction B(B--->D(*0)K(*-))=(8.3+/-1.1(stat)+/-1.0(syst)) x 10(-4), and the fraction of longitudinal polarization in this decay to be Gamma(L)/Gamma=0.86+/-0.06(stat)+/-0.03(syst).

Measurements of the mass and width of the eta(c) meson and of an eta(c)(2S) candidate.

The mass m(eta(c)) and total width Gamma(eta(c))(tot) of the eta(c) meson have been measured in two-photon interactions at the SLAC e(+)e(-) asymmetric B Factory with the BABAR detector. With a sample of approximately 2500 reconstructed eta(c)-->K(0)(S)K+/-pi(-/+) decays in 88 fb(-1) of data, the results are m(eta(c))=2982.5+/-1.1(stat)+/-0.9(syst) MeV/c(2) and Gamma(eta(c))(tot)=34.3+/-2.3(stat)+/-0.9(syst) MeV/c(2). Using the same decay mode, a second resonance with 112+/-24 events is observed with a mass of 3630.8+/-3.4(stat)+/-1.0(syst) MeV/c(2) and width of 17.0+/-8.3(stat)+/-2.5(syst) MeV/c(2). This observation is consistent with expectations for the eta(c)(2S) state.