Study of family clusters of COVID-19 in the Ústí nad Labem Region with a focus on children - clinical picture, secondary transmission, antibody response.

OBJECTIVE: The article presents the results of a study of family clusters of COVID-19 whose aim was to describe the clinical course of the disease in children, to identify secondary transmission in households with infected children, and to find out the differences in the antibody response between children and adults. Data were collected from 3 March 2020 to 25 October 2020, that is at the time when the alpha or delta variants were not dominant. METHODS: A retrospective analysis of data on infected children in the Ústí nad Labem Region collected by the Regional Public Health Authority along with questionnaire data reported by their families. Serological tests were performed in study volunteers. RESULTS: The most common symptoms in children were headache, runny nose, and loss of smell and taste. The hospital admission rates were 0.8% in children and 2.4% in adults. The secondary transmission rate in families where the index case was a child reached 22.6%. It was higher when the index case was a child 11-15 years of age or asymptomatic. The secondary transmission rate in families where the index case was an adult equalled 77.1%. Children had higher IgG antibody levels than adults at post-infection months 4 and 5, but their seropositivity rate was comparable to that of adults. CONCLUSION: Children have a nonspecific clinical course of the disease, which is quite similar as other viroses, and rarely require hospital admission. Secondary transmission in families where the index case was a child is not uncommon and is also possible through contact with an asymptomatic child. After recovery, children have higher levels of antibodies at post-infection months 4 and 5.

Functionalized hydrogel microparticles prepared by microfluidics and their interaction with tumour marker carbonic anhydrase IX.

Microfluidics allows precise control of the synthesis of microparticles for specific applications, where size and morphology play an important role. In this work, we have introduced microfluidic chip design with dedicated extraction and gelation sections allowing to prepare hydrogel particles in the size range of a red blood cell. The influence of the extractive channel size, alginate concentration and type of storage media on the final size of the prepared alginate microparticles has been discussed. The second part of the work is dedicated to the surface modification of prepared particles using chitosan, pHPMA and the monoclonal antibody molecule, IgG M75. The specific interaction of the antibody molecule with an antigen domain of carbonic anhydrase IX, the transmembrane tumour protein associated with several types of cancer, is demonstrated by fluorescence imaging and compared to an isotypic antibody molecule.

The duration of SARS-CoV-2 shedding in patients recovering from COVID-19.

The knowledge of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) shedding is highly relevant to the diagnosis, treatment and follow-up of patients with COVID-19 (coronavirus disease 2019). Deep nasopharyngeal swabs repeatedly collected from a cohort of one hundred patients with COVID-19 were tested for SARS-CoV-2 RNA using RT-PCR (real-time polymerase chain reaction). The median period of viral genome detectability was 15 days. Furthermore, the authors tested the hypothesis on the relationship between the severity of COVID-19 and the period in which the viral genome is detectable. They did not find any statistically significant difference in the duration of viral clearance between patients with asymptomatic to mild disease or severe disease.

Fluorescent Probes for Monitoring Cholesterol Trafficking in Cells.

Cellular cholesterol plays fundamental and diverse roles in many biological processes and affects the pathology of various diseases. Comprehensive and detailed understanding of the cellular functions and characteristics of cholesterol requires visualization of its subcellular distribution, which can be achieved by fluorescence microscopy. Many attempts have been made to develop fluorescent cholesterol reporters, but so far, none of them seems to be ideal for studying all aspects of cholesterol management. To meet the requirements for the right probe remains a great challenge, and progress in this field continues. The main objective of this review is to not only present the current state of the art, but also critically evaluate the applicability of individual probes and for what purpose they can be used to obtain relevant data. Hence, the data obtained with different probes might provide complementary information to build an integrated picture about the cellular cholesterol.

Striking antitumor activity of a methinium system with incorporated quinoxaline unit obtained by spontaneous cyclization.

A novel pentamethinium salt was synthesized with an unforeseen expanded conjugated quinoxaline unit directly incorporated into a pentamethinium chain. The compound exhibited high fluorescence intensity, selective mitochondrial localization, high cytotoxicity, and selectivity toward malignant cell lines, and resulted in remarkable in vivo suppression of tumor growth in mice.

[Esophageal replacement using large intestine--experience with 109 cases]. / Náhrada jícnu tlustým strevem--zkusenosti se 109 prípady.

Use of large intestinal transplants in esophageal replacement is an uncommonly used alternative. The authors discuss its indications in benign, as well as in malignant disorders and, based on them, assign them into three groups. Based on historical data and their professional experience, they present reasons for the commonest uses of particular parts of the large intestine. They evaluate introperative, as well as long-term outcomes.

[Video-assisted esophageal resection for carcinoma--ten-year experience]. / Videoasistovaá resekce jícnu pro karcinom--desetileté zkusenosti.

INTRODUCTION: Esophageal procedures belong to the most complicated gastrointestinal procedures. Therefore, esophageal carcinoma patients have been and still are concentrated into specialized centres, equipped with all diagnostic and therapeutic means. At the Ist Surgical Clinic of the LF UP (Medical Faculty of the Palacky University) in Olomouc, esophageal surgery has a long lasting tradition. In the management of malignant esophageal disorders, the clinic prefers the use subtotal esophageal resection, attaching the esophagus transplant to a cervical esophageal stud, to the use of more saving resection with the anastomosis site in the mediastinum. In order to substitute for the resected esophagus, the authors normally use a tubulized gastric flap. In cases, where the stomach cannot be used, the authors use transverse colon to replace the resected esophagus. Classical esophageal procedures have nearly entirely been replaced by video-assisted procedures. Most esophageal resections are performed using video-assisted laparoscopic transhiatal approach. In the management of esophageal tumors which are located at the level of tracheal bifurcation, or below it, the authors use right- sided thoracoscopic approach. MATERIAL AND METHODS: During the past 10 years, 178 patients have undergone subtotal esophageal resection for esophageal carcinoma. In 81 patients (45.5%), the esophagus was resected using classical approach. 35 subjects underwent transhiatal "blind"extirpation according to Orringer, in 46 subjects right-sided thoracotomy was used (subjects with tumors located in the middle third of the thoracic esophagus and higher). Video-assisted approach was used in 97 patients, which included 88 subjects with laparoscopic transhiatal modification of the procedure and 9 subjects, who underwent video-thoracoscopy. OUTCOMES: The mean procedure duration was 242 minutes. The authors recorded the following complications: pneumothorax in 29 patients (16%) and n. laryngeus recurrens palsy in 16 subjects (9%). 13 patients (7%) developed a fistule in anastomosis, which was managed by drainage of the cervical wound. Pulmonary complications were recorded in 55 patients (31%). The mean duration of hospitalization was 12 days, intraoperative death rate was 4.5%. Only 2 out of 8 deaths occurring during the early postoperative period, were surgery-related. In the both cases, mediastinitis developed, resulting from a transponate necrosis in one of the cases and from a bronchial fistule in the other subject. Five subjects exited because of ARDS, which included one case of myocardial infarction. CONCLUSION: When esophageal carcinoma is managed at a clinic equipped with the latest modern diagnostic and therapeutical means, the procedure of esophageal resection is a fairly safe procedure with low death and morbidity rates.

[Iatrogenic bile ducts injuries]. / Iatrogenní poranení zlucových cest.

AIM: To evaluate therapeutic options and outcomes of repair of iatrogenic bile duct injuries during cholecystectomy, which were solved in our institution over the past five years. The incidence of this injury is stated in the range of 0-0.4% for open cholecystectomy and 0-0.7% for laparoscopic cholecystectomy. METHODS: Authors present a group of ten patients who were operated on for iatrogenic bile duct injury incurred during cholecystectomy in 2005-2009. All patiens were refered from other hospitals. Three men and seven women aged 20-71 years. The bile duct injury occured twice during open procedure and during laparoscopic procedure in eight. Incomplete lesion was idenified in one case, complete lesions with tissue loss were found in nine patients. Right hepatic artery injuries were found in four patients with tissue loss injury. Nine patients required reconstruction of the biliary tract using hepaticojejunoanastomosis with Roux-Y loop. RESULTS: The bile leak occurred in two patients after reconstruction. In one patient was required early percutaneous transhepatic drainage. The early death occurred in a patient with a complicated course, where our reconstruction of the biliary tract was already in the field of advanced biliary peritonitis as a third operation during 7 days. All other patients are monitored postoperatively at regular intervals in our clinic. They carried out clinical examinations and monitoring of liver enzymes. In the long interval from reconstruction (6-12 months) anastomotic stenosis occurred in three patients. Postoperative radiological intervention in the form of dilation of anastomosis and prolonged transient transanastomotic drainage was necessary (the duration of drainage was 6-7 months). CONCLUSION: Iatrogenic bile duct injury is a serious condition threatening the patient's life from the progressive failure of liver function on the basis of secondary biliary cirrhosis. Due to the nature of lesions arising from laparoscopic cholecystectomy (loss tissue injuries, thermal damage to surrounding structures, the hepatic artery injuries) reconstructions are extremely difficult. For most patients reconstructive operations are the last possible surgical procedures in this area, except for liver transplantation. Hilar reconstructions have a higher probability of stenosis of the anastomosis. If they occur, there are repeated cholangitis, which pass into the secondary sclerosing cholangitis and cause secondary biliary cirrhosis, with all the consequences of disease (portal hypertension, bleeding esophageal varices). For these reasons, it is necessary for careful long-term postoperative monitoring of liver function and good interdisciplinary cooperation, especially with the intervention radiologist in management postoperatively evolving stenosis of anastomoses. It is necessary for the early identification and indication of radiological interventions in order to prevent damage to the liver parenchyma.

[Analytical methods at the boundary between biochemistry and immunology]. / Vysetrovací metody na pomezí biochemie a imunologie.

The article presents assays shared by both disciplines; i.e the specialization 801 (Clinical Biochemistry) and 813 (Laboratory of Allergology and Immunology), and it covers over 60 tests. It is intended as reference information for general practitioners, as well as for laboratory workers at the beginning of their studies. Emphasis is laid on some facts which GPs ordering laboratory determinations should be familiar with; the pre-analytical stage (specimen collection, their transport and storage), the analytical reliability of particular methods, their accessibility, frequency and total costs. Analytical techniques are only mentioned marginally as their understanding is not essential for GPs. Assuming the readers' fundamental experience of diagnostic applications of the methods discussed; we only comment some obsolete or rare tests. The shared assays cover selected analyses of proteins (incl. some enzymes and tumormarkers), ions, osmolality and quantitative microscopic urinalysis.

Functionalization of PVC membrane with ss oligonucleotides for a potentiometric biosensor.

A novel application of a single stranded (ss) oligonucleotide as an active component of polymeric membrane in an ion-selective electrode (ISE) is described. The original oligonucleotides, oligo(dA)(15), modified by cholesterol, triphenylmethyl and hexadecyl derivatives, were immobilized into poly(vinyl chloride) (PVC) membrane using extraction protocol. In parallel, the adsorption protocol was used to immobilize unmodified oligo(dA)(15) on the PVC membrane based on tridodecylmethyammonium chloride (TDDMA(+)Cl(-)). Immobilization of ss oligonucleotide probe through spacer was more effective for the potentiometric detection of the hybridization between complementary oligonucleotides. It was found that cholesterol-oligo(dA)(15) modified membranes were sensitive toward complementary oligo(dT)(15) in the concentration range 2-80 nM at pH 7. An explanation for the detection mechanism is proposed.

Temporary aorto-aortal bypass used during extended pneumonectomy for lung cancer.

Involvement of the aortic arch, or the descending aorta, is not uncommon in left-sided lung tumours. The direct invasion of the aortic wall is generally considered a contraindication in lung resection. However, there are a limited number of reports of full thickness resections of the aorta during lung cancer surgery. They may be accomplished as a partial resection using a patch, or as a local tubular resection with reconstruction by a graft. In order to prevent ischaemia of the spinal cord, a cardiopulmonary bypass is usually recommended. The authors present a case report of a full thickness tubular resection of the descending aorta during pneumonectomy for centrally located lung carcinoma. The direct invasion to the descending aorta was only confirmed intraoperatively. After tumour dissection, two aortal cannulas were inserted into the aorta: the first one into the aortic arch over the left subclavian artery, the other one into the descending aorta over the diaphragm. They were then bypassed without a pump. The descending aorta was cross-clamped and replaced by a Dacron graft. There were no early complications : the patient has already survived two years after surgery with no recurrence.

[Analysis of regressive changes in the lung carcinoma lymphatic metastases following induction chemotherapy]. / Analýza regresivních zmen v lymfatických metastázách plicního karcinomu po indukcní chemoterapii.

BACKGROUND: Prognosis of higher stages of non-small cell lung cancer (NSCLC) is very poor. Only 13% of patients in stage IIIA survive 5 years after the diagnosis determination. The purpose of neoadjuvant (inductive) therapy is to eliminate haematogenous and lymphogenous metastases and to cause a cytoreduction in the primary tumor before the resection. Especially detection of lymphogenous metastases is the main factor in the indication of the pre-operative chemotherapy, but this therapy is frequently indicated according to CT without any bioptic verification. The authors suppose such a discrepancy in radiological and histo-pathological staging to influence in a positive sense rather optimistic results of therapeutic protocols, which include the pre-operative chemotherapy. METHODS: A biopsy of the lymph nodes was performed as a part of the staging. If the metastasis was proved, the lymph node was labeled and the patient was treated by 3 cycles of the pre-operative chemotherapy. The 57 labeled lymph nodes were removed during the subsequent lung resection and lymphadenectomy. An analysis of regressive alterations in the lymphatic metastases of lung cancer after an inductive chemotherapy and comparison with the pre-operative bioptic findings have quantificated the chance of the inductive therapy to eliminate lymphatic metastases. RESULTS: The clinical down-staging was stated in 21 cases (36.8%), but the viable malignant cells rested in the majority 50 (87.7%) of the taken labeled lymph nodes 57 (100%) even after the neoadjuvant therapy. On the other hand, the satisfactory tumor regression changes was proven in 49 (86%) lymphatic metastases. CONCLUSIN: The results of the study may modify an indicating judgment in the therapy of locally advanced stages of lung cancer because it has brought a new view to the results of neoadjuvant therapy.

Quo vadis porphyrin chemistry?

This review summarizes recent developments in the area of porphyrin chemistry in the direction of biological applications. Novel synthetic methodologies are reviewed for porphyrin synthesis, porphyrin analog synthesis, stable porphyrinogens -- calixpyrroles, expanded porphyrins. Unique biological properties of those compounds are desribed with focus on photodynamic therapy (PDT) and molecular recognition properties. Special attentions given to metalloporphyrins with potential to affect heme degradation and CO formation.

[Duplication of the terminal ileum--a case review]. / Duplikatura terminálního ilea--kazuistika.

Duplications of the gastorintestinal tract are fairly rare developmental anomalies. They may occur throughout the gastrointestinal tract, however, most commonly, they occur in the small intestine. They are usually diagnosed in early childhood, however, they may be asymptomatic first and cause symptoms as late as in adulthood. Symptoms of,,urgent abdominal conditions", ranging from symptoms of intestinal obstruction, perforation to symptoms of bleeding from the GIT, prevail. A rare finding of a carcinoma in the duplication has been recorded. The etiopathogenesis has not been fully understood. The treatment is surgical. The authors present a case-review of the terminal ileum duplication in a child with symptoms of intestinal obstruction, resp. invagination.

Synthesis and deposition of a Tröger's base polymer on the electrode surface for potentiometric detection of a neuroblastoma tumor marker metabolite.

The development of novel diagnostic tools is a primary goal in bioanalytical chemistry. Here we report the synthesis of Tröger's base functionalized with amino- and coumarin-units designed as a monomeric unit for the development of an electrochemical cancer sensor. The synthesized receptor was deposited onto a conducting support using electrochemical polymerization, characterized spectroscopically and tested potentiometrically towards metabolites used as tumor markers of neuroblastoma.

[Antibody response to Ascaris lumbricoides among the children population in the Ustí Region]. / Protilátková odpoved' na Ascaris lumbricoides v populaci detí Usteckého kraje.

A group of 156 children aged between 10 and 12 years were screened for IgG and IgE antibodies to Ascaris lumbricoides. The study subjects were 64 children of Romany origin and 92 children from the majority population. IgG antibodies to Ascaris lumbricoides were detected in 112 (71.8%) children. No difference in the prevalence of IgG antibodies was found between Romany children and those from the majority population. As many as 34.1% of the study subjects had IgE antibodies to Ascaris lumbricoides, again with no difference between the two ethnic groups. Children with IgG antibodies to Ascaris lumbricoides had significantly higher total IgE levels compared to those who had tested IgG negative. To demonstrate induction of a non-specific IgE response was one of the study objectives. The high prevalence rates of IgG and IgE antibodies to Ascaris lumbricoides are suggestive of a high frequency of cross- and non-specific reactions. Possible effect of cross-reactivity to other antigens on the specific IgG and IgE antibody response to Ascaris lumbricoides is discussed.

[The technique of securing sentinel lymph nodes in tumors of the distal oesophagus and the stomach ]. / Technika získání sentinelových uzlin u tumoru v oblasti distálního jícnu a zaludku.

The authors discuss the technique of identification and biopsy of sentinel lymph nodes in tumors of the upper gastrointestinal tract. They describe difficulties and problems of the technique, in which the identified sentinel lymph node is obtained mainly employing endoscopical and minimally invasive techniques.

Successful HLA-identical sibling cord blood transplantation in a 6-year-old boy with leukocyte adhesion deficiency syndrome.

A 6-year-old boy with the severe form of the leukocyte adhesion deficiency syndrome (LAD) received a transplant of cord blood (CBT) from his HLA-identical brother. The donor was proved healthy by successful prenatal diagnosis. CBT was performed after conditioning with etoposide, busulfan and cyclophosphamide. After hematopoietic recovery complete chimerism was proved as well as the normal expression of CD11x/CD18 complex on circulating leukocytes. The only post-transplant complication was a mild pneumonitis resolving on the corticosteroid therapy. Thirteen months after CBT the boy is in good health and shows no signs of immunodeficiency. As far as we know this is the first report of successful CBT in a patient with LAD syndrome.

Psychosocial problems of the aged: a shared medical responsibility.

The respective roles of the psychiatrist and the family physician in dealing with the psychologic and some of the social problems of the aged are briefly outlined. By close cooperation of these two groups of physicians, many aged patients can be helped. More important is the fact that both groups of physicians can contribute to a change in attitude toward aging among the younger members of society. This offers hope that many of the psychosocial problems of the aged can be minimized or prevented.

Clinical value of the London Psychogeriatric Rating Scale.

The London Psychogeriatric Rating Scale (LPRS) was developed in answer to the demand for a reliable psychometric rating scale suited to a psychogeriatric population. All inpatients on a Psychogeriatric Unit (approximately 140 at any specific time) were rated with the LPRS every third month for an 18-month period. The 4 components of the total score include a measure of mental status originally derived by factor analysis. Predictive validity has been established in terms of various clinically relevant areas including the following: a) ward placement; b) outcome (continued hospitalization, discharge, or death); c) diagnosis (by scoring levels and progress patterns across time); and d) ability of the patient to function in, or benefit from, a particular treatment program. The scale has been used successfully to assess a given patient's progress quantitatively and globally over a long period.