Fungal communities in soils under global change.

Soil fungi play indispensable roles in all ecosystems including the recycling of organic matter and interactions with plants, both as symbionts and pathogens. Past observations and experimental manipulations indicate that projected global change effects, including the increase of CO2 concentration, temperature, change of precipitation and nitrogen (N) deposition, affect fungal species and communities in soils. Although the observed effects depend on the size and duration of change and reflect local conditions, increased N deposition seems to have the most profound effect on fungal communities. The plant-mutualistic fungal guilds - ectomycorrhizal fungi and arbuscular mycorrhizal fungi - appear to be especially responsive to global change factors with N deposition and warming seemingly having the strongest adverse effects. While global change effects on fungal biodiversity seem to be limited, multiple studies demonstrate increases in abundance and dispersal of plant pathogenic fungi. Additionally, ecosystems weakened by global change-induced phenomena, such as drought, are more vulnerable to pathogen outbreaks. The shift from mutualistic fungi to plant pathogens is likely the largest potential threat for the future functioning of natural and managed ecosystems. However, our ability to predict global change effects on fungi is still insufficient and requires further experimental work and long-term observations. Citation: Baldrian P, Bell-Dereske L, Lepinay C, Vetrovský T, Kohout P (2022). Fungal communities in soils under global change. Studies in Mycology 103: 1-24. doi: 10.3114/sim.2022.103.01.

Durable Complete Response of Colorectal Cancer Metastasis after Biochemotherapy.

BACKGROUND: Resection of the metastatic site is indicated but not always possible in patients with metastatic colorectal cancer (mCRC) who achieve a partial or complete response (CR) to induction systemic treatment. CR after systemic treatment alone is uncommon, and even patients with radiologic CR after induction chemotherapy harbour persistent macroscopic or microscopic residual disease in more than 80% of cases. Occasionally, some metastatic lesions disappear radiologically but others persist after induction systemic treatment. The indication and extent of metastasectomy in these situations is controversial, especially regarding sites with completely regressed metastases. CASE: This case report describes a patient with mCRC who achieved a long-term response after biochemotherapy and incomplete metastasectomy. One of the known liver lesions could not be removed due to its disappearance after induction biochemotherapy with FOLFOX and bevacizumab. Further adjuvant chemotherapy using the FOLFOX regimen was administered postoperatively. The patient has been meticulously followed by radiology including repeated positron emission tomography/computed tomography and magnetic resonance scans, clinical examination and tumour markers. No recurrence of cancer has been detected after a follow-up of 5 years. RESULTS AND CONCLUSION: CR to systemic treatment is uncommon, but this case report demonstrates that it can be durable in patients with colorectal cancer and liver metastases. This case report indicates that some patients with mCRC can be cured with systemic therapy only, challenging the prevailing paradigm of mCRC therapy.Key words: colorectal cancer - metastasis - chemotherapy - molecular targeted therapy - diagnostic imaging.

[The new blood test bio-marker SEPT9 and colorectal carcinoma screening]. / Nový krevní test bio-markeru SEPT9 a screening kolorektálního karcinomu.

Due to its high incidence and mortality rates, the colorectal carcinoma represents a crucial medical issue. However, when it is detected in early stage there is high rate of successful treatment. Thats why, early stage cancer screening programmes were introduced into the clinical practice. They focus on the finding of hidden bleeding, using various laboratory techniques, sigmoidoscopy, and, primarily, colonoscopy. However, screening programmes have not yet reached the effect required. New techniques are therefore being developed, such as the detection of blood bio-markers. This group includes also methylated SEPT9 (mSEPT9) detection in blood. We applied this test on 57 patients; we divided the group into two parts. There were 33 asymptomatic individuals in the first group. In this group, we were got only one positive mSEPT9 result. The consequent colonoscopies were negative. The other group had 24 proven carcinomas. Of them, two had negative mSEPT9 results. The remaining in all 22 patients was tested mSEPT9 positive. After its efficiency is tested by further studies, this test may be used especially for patients with low compliance, as it only requires routine blood drawing.

Probiotic treatment with Probioflora in patients with predicted severe acute pancreatitis without organ failure.

BACKGROUND: We previously demonstrated that probiotic prophylaxis, in patients with predicted severe pancreatitis, did not prevent infectious complications but unexpectedly increased the risk of bowel ischemia and mortality. The suggestion that these negative findings are only observed in the presence of organ failure at the start of probiotic treatment has not been confirmed. METHODS: In a retrospective analysis, all patients with predicted severe acute pancreatitis without initial organ failure admitted to a medium care facility of a teaching hospital in Prague from January 2003 to December 2010 were included. All patients routinely received probiotic treatment with Probioflora. Total parenteral nutrition (TPN) was routinely started and shifted toward total enteral nutrition. Infectious complications, mortality and the incidence of bowel ischemia were recorded. RESULTS: 99 consecutive patients, mean age 56 years, were included. Infectious complications occurred in 42 patients (42%), consisting of bacteremia (n = 40), pneumonia (n = 11) and infected necrosis (n = 11). Bowel ischemia was detected in two patients (2%). Overall mortality was 8%. CONCLUSION: In this retrospective study no apparent positive or negative impact of probiotic treatment with Probioflora was demonstrated when administered to patients with predicted severe acute pancreatitis without initial organ failure.

Changes in small intestine permeability after radiotherapy of malignant tumor.

BACKGROUND/AIMS: Radiotherapy of the malignancy in the small pelvis causes different adverse events in normal tissues. The small intestine is the most sensitive organ in this region. Its wall performs the barrier function between internal and external environments. The damage to the intestinal barrier brings increase in the intestinal permeability. The aim of this study was to find out dependency of intestinal permeability disorder on certain factors such as age, radiation dose, target volume, dose per fraction, added chemotherapy etc. METHODOLOGY: We evaluated the intestinal permeability by the LAMA (lactulose-mannitol) test in a group of 31 patients with a diagnosis of malignant gynecological tumor (24), rectal cancer (6) and prostate cancer (1) who underwent radiotherapy of the small pelvis with doses of at lest 45.0Gy. Fourteen patients underwent adjuvant radiotherapy, and 17 patients underwent a primary radical radiotherapy. In the latter group there was a tumor at the time of radiotherapy. The measurement was performed 3x (before starting radiotherapy, after its completion, and 6 months after completion). Complications after radiotherapy were assessed according to RTOG classification. LAMA test resultswere statistically worked out. RESULTS: Early complications G1, G2 were observed in 22 patients, late complications G1 in 3 patients. No dependency has been proved between grade of complications and intestine permeability changes. No evidence has been found in dependency on the patients' age, target volume, added chemotherapy, size of fraction, energy of radiation or other factors either. Connection of intestine permeability changes and total dose was on the margin of statistical significance; the only statistically significant relation was between intestinal permeability change and presence of tumor in the organism which was very surprising and cannot yet be explained. CONCLUSIONS: More patients should be involved in the study and late postirradiation changes should be assessed at a longer time interval.

[Pseudomembranous colitis]. / Pseudomembranózní kolitida.

For some thirty years it has been known that pathologic proliferation oftoxigenic Clostridium difficile may lead to inflammation of colonic mucosa which, in its fully developed form, manifests as pseudomembranous colitis. CDAD (Clostridium difficile - Associated Disease or Diarrhoea) is the term which is generally and quite aptly used for the disease in literature on the subject. In most cases, the disease develops after the administration of broad-spectrum antibiotics, yet there are also other important pathogenetic factors involved which should not be ignored. The disease has grown in significance over recent years due to the occurrence of serious epidemics in a number of advanced countries provoked by a highly virulent strain characterised as ribotype 027, toxinotype III, pulsovar NAP1. CDAD is a potentially fatal disease, yet it can be effectively cured if diagnosed on time. Stool toxin testing plays a crucial role in the diagnostics of the disease, and the use of endoscopy has been on the rise. Administration of targeted antibiotics is of critical importance for successful therapy, metronidazol or orally administered vankomycine being considered the most reliable, and there are also other drugs with promising effects. However, the rate of recurrence of the disease is as high as 25%. In view of the realistic threat of propagation of the highly virulent strain in the territory of the Czech Republic, preparations have started for the setting up of a national reference laboratory for Clostridium difficile typification.

[Endoscopic cytoscopy in examination of the digestive tract]. / Význam endoskopické cytoskopie u vysetrení trávicího traktu.

A number of new endoscopic methods have been developed recently, which aim to allow the most accurate possible viewing of the mucosa of the digestive tract. These procedures include endoscopic cytoscopy, which together with confocal endoscopy is a technique of so-called endoscopic microscopy. By means of enodcytoscopy it is possible to view "in vivo" the morphological details of the surface of the mucosa of the digestive tract. The mucosa must, however, be thoroughly cleaned and stained with methylene blue. The paper presents our own initial experience of this method, which may lead to faster and more accurate diagnosis of pre-tumorous or tumourous inflammation processes in the mucosa of the digestive tract.

[Faecal elastase I--its use in diagnosis of chronic pancreatitis]. / Stanovení elastázy I ve stolici--vyuzití v diagnostice chronické pankreatitidy.

BACKGROUND: The diagnosis of chronic pancreatitis is based on the imaging methods. These imaging methods show the main morphological changes in the pancreatic ducts and its parenchyma, but they do not define the function of the pancreas. The aim of our study was Faecal Elastase I. determination in patients with chronic pancreatitis. The test is a simple, non-invasive method of the investigation of the pancreatic exocrine insufficiency. The Faecal Elastase I occurring in the stool was correlated with the level of the damage of pancreatic tissue together with the control group of the patients with different diagnoses. METHODS AND RESULTS: Faecal Elastase I (mean values in ug/g of stool) detection is a simple, non-invasive method which correlates well with the damage of pancreatic tissue, stemming from chronic pancreatitis. This test is routinely used especially in the diagnosis of chronic pancreatitis. The classification of chronic pancreatitis currently depends on the morphological changes of the pancreatic duct system (the patho-morphological changes). We are currently missing the classification describing simultaneously the morphological changes of the gland and the function of the pancreas. In our studies we have used a newly proposed classification system, which was put together in Bern, 2000 (1). This new system encompasses morphological and functional changes. Faecal Elastase I was determined by a microplate ELISA method using monoclonal antibody to human pancreatic protein. The Faecal Elastase I. was tested in the stool of the 196 patients with chronic pancreatitis stemming from alcoholism. The occurrence of Faecal Elastase I. was classified according to the levels assigned by the classification system. The control group used in this study included 144 patients with different diagnoses. The results demonstrate a very good correlation of Faecal Elastase I. with the grading of the newly proposed classification system of chronic pancreatitis. Patients with the highest levels of the damage of the pancreas had a significantly lower occurrence of Faecal Elastase I. in comparison with the non-pancreatic control group and in patients with chronic pancreatitis who had no clinical complications or damage of endocrine and exocrine functions of the pancreas. CONCLUSIONS: Feacal Elastase I performance plays an important role in diagnosing of the severe cases of chronic pancreatitis and in the follow-up of the chronic pancreatitis in the patients with the intermediate damage of the pancreas.

Intestinal permeability in patients with chemotherapy-induced stomatitis.

PURPOSE: Mucositis represents one of the most common side effects of chemotherapy, and may affect any part of the gastrointestinal tract, resulting in stomatitis, dysphagia, dyspepsia, or diarrhea. The aim of the present study was to evaluate intestinal permeability in patients with stomatitis during treatment with oral granulocyte-monocyte colony-stimulating factor (GM-CSF, Leucomax). METHODS: Ten patients with chemotherapy-induced stomatitis and 21 control cancer patients were included in the study. Intestinal permeability in patients with stomatitis was evaluated before and after the treatment with oral GM-CSF (200 micrograms for 4 consecutive days) by measuring urinary lactulose, D-xylose, and mannitol after oral challenge in collected urine using capillary gas chromatography. RESULTS: Mean grade of stomatitis (3, range 2-3) improved during treatment by a mean of 1 grade (range 0-2, sign test P < 0.05) with an improvement observed in eight of ten patients. Lactulose excretion, lactulose/mannitol, and lactulose/xylose ratios were markedly elevated in the patients with mucositis compared with 21 control cancer patients (1.60 +/- 1.04%, 0.2446 +/- 0.2937, and 0.3877 +/- 0.6808 vs 0.35 +/- 0.20%, 0.0332 +/- 0.0148, and 0.0255 +/- 0.0086, respectively, Mann Whitney U-test, P < 0.001). After treatment, lactulose excretion, lactulose/mannitol, and lactulose/xylose ratio decreased significantly (1.60 +/- 1.04 vs 0.63 +/- 0.42%; 0.2446 +/- 0.2937 vs 0.1303 +/- 0.1149; and 0.3877 +/- 0.6808 vs 0.1126 +/- 0.1146, respectively, P < 0.05). CONCLUSIONS: Lactulose excretion after oral challenge, lactulose/mannitol, or lactulose/xylose ratio may be useful markers for intestinal involvement in chemotherapy-induced mucositis. Improvement of oral mucositis was associated with a significant decrease of intestinal permeability to lactulose. Testing of intestinal permeability by the present method may be useful to evaluate the effect of therapeutic interventions in patients with chemotherapy-induced mucositis.

Small bowel permeability in patients with cytostatic therapy.

The purpose of this study was to examine the influence of cytostatic therapy on the barrier function of the small bowel. In 16 patients with tumors in the gastrointestinal tract with metastatic involvement of the liver, small bowel permeability was measured using the lactulose/mannitol test. The patients were treated for 5 d with fluorouracil (750-1000 mg/d) and leucovorin (25-50 mg/d). The examination was performed on the first day, at the beginning of the cytostatic therapy, and also 5, 12, and 28 d after the therapy had begun. In comparing the start and the end of this therapy, the index of permeability was significantly increased (as measured 7 d after the end of therapy). These results show the damage of small bowel barrier after cytostatic therapy.

[Passive transfer of tuberculin sensitivity (author's transl)]. / Zur passiven Ubertragung der Tuberkulinreaktivität

Tuberculin sensitivity can be transfered passively by cells. The active principle may be bound on T-lymphocytes. In patients with sarcoidosis or with malignant lymphadenomas, the passive transfer of tuberculin sensitivity via lymphocytes of tuberculin-positive donors is more difficult. In sarcoidosis the achievement of a positive tuberculin reaction at an appreciable distance from the site of transfer was possible only with markedly greater amounts of donor lymphocytes than in healthy controls. In patients with malignant lymphadenomas such a transfer succeeded only very rarely. The qualitative and quantitative differences in the impairment of the delayed immune sensitivity in both groups and their possible causes are discussed.

Small bowel permeability in diagnosis of celiac disease and monitoring of compliance of a gluten-free diet (gut permeability in celiac disease).

BACKGROUND & AIM: Celiac disease is an autoimmune disease with the damage of the intestinal barrier. The aim of study was to measure gut permeability in patients with untreated celiac disease and during treatment with a gluten free diet. METHODS: 30 patients with celiac disease before and during treatment with gluten-free diet were investigated, 30 patients without organic damage of the gastrointestinal tract served as control. Small bowel permeability was measured using lactulose/mannitol and lactulose/D-xylose ratios. The saccharides were examined in the 5 hours collected urine using capillary gas chromatography. RESULTS: Small bowel permeability (indices lactulose/mannitol and/or lactulose/xylose) increased significantly in patients with untreated celiac disease. 23 patients were followed up before and during treatment with a gluten-free diet 2-6 months after beginning of this treatment and small bowel permeability (measured as indices lactulose/mannitol and/or lactulose/xylose) significantly decreased. CONCLUSION: Small bowel permeability test is a non-invasive test suitable for the diagnosis of celiac disease and monitoring of compliance to a gluten-free diet in these patients.

[Intestinal permeability in relatives of patients with Crohn's disease]. / Strevní propustnost u príbuzných pacientu s Crohnovou chorobou.

The etiology of Crohn's disease remains unknown, one of theories is the damage of bowel wall with the impairment of small bowel barrier. In patients with Crohn's disease was found high level of small bowel permeability in dependence of disease activity. The aim of our study was to measure small bowel permeability in first-degree relatives of the patients with Crohn's disease. In 14 first-degree relatives of Crohn's disease patients (7 men, 7 women) there was measured small permeability using lactulose, mannitol and D-xylose. Sugars were investigated in 5 hour collected urine and examined using capillary gas chromatography. The absorption of all the sugars--lactulose, mannitol and D-xylose did not differ from healthy controls. The small bowel permeability index (lactulose/mannitol) did not differ from healthy controls too (0.023 vs. 0.019, p = 0.451). These preliminary results confirms the theory, that there is no damage of small bowel barrier in first degree relatives of Crohn's disease patients.

[Intestinal permeability in patients with food allergy]. / Vysetrení strevní propustnosti u pacientu s potravinovou alergií.

The authors examined the intestinal permeability using the lactulose mannitol test in 13 women, mean age 45.7 years with a confirmed food allergy before they were on an elimination diet. The intestinal permeability did not differ significantly in these patients as compared with healthy volunteers. The intestinal permeabiity test with lactulose and mannitol thus cannot be recommended on the basis of these results for the diagnosis of food allergy.

[Puncture gastrostomy in oncologic patients]. / Vyuzití punkcních gastrostomií u onkologických nemocných.

Puncture gastrostomies--percutaneous endoscopic gastrostomy and radiologically assisted gastrostomy--are minimally invasive methods to ensure an approach for the administration of enteral nutrition. These methods replaced the insertion of tubes during surgery (surgical gastrostomy). Percutaneous endoscopic gastrostomy (PEG) is inserted by means of a gastroscope, usually by the pull method, radiologically assisted gastrostomy (RAG) is implemented after insufflation of the stomach by a thin tube directly across the abdominal wall by the push method. In oncological patients it is preferable to administer enteral nutrition via puncture gastrostomy in case of obstruction of the upper portion of the digestive tract (oral cavity, larynx, pharynx, oesophagus), in deglutition disorders caused by cerebral tumours or in order to improve the nutritional status of patients with tumour cachexia. In the authors group in 1995-2000 a total of 53 puncture gastrostomies were made in 53 patients, 37 men and 16 women, mean age 62 years (32-94 years, incl. 38 PEG and 15 RAG. In 30 patients the reason was obstruction of the upper digestive tract, in 11 patients impaired swallowing associated with a cerebral tumour and in 12 patients the cause was tumourous cachexia. Puncture gastrostomies are well tolerated by the attending staff and patients, in oncology they can be used for administration of enteral nutrition under hospital and domiciary conditions.

[Monitoring phagocyte activity and free radicals in Helicobacter pylori infections]. / Monitorace aktivity fagocytu a volných radikálu u infekce Helicobacter pylori.

The presence of infection in organism induces a lot of Immunological reactions accompanied by creating free Radicals and reactive oxygen species (ROS). These play an important role in elimination of bacteria but also in tissue injury in surrounding. The aim of presented study was to focus on monitoring of ROS and phagocyte activation in subjects infected by Helicobacter pylori (HP) and thus to contribute to our knowledge of the etiopathogenic role of HP in inflammatory gastrointestinal diseases. The results report some differences, which interpretation opens a lot of questions showing how important of role ROS in HP infection may play.

[Disorders of heart rhythm in hypertrophic cardiomyopathy]. / Poruchy srdecního rytmu u hypertrofických kardiomyopatií.

In 64 patients with hypertrophic cardiomyopathy 24-hour Holter monitoring of the ECG was made in order to detect the incidence of individual disorders of the cardiac rhythm. The examination revealed a large number of potentially malignant ventricular arrhythmias (47% of the patients). Most frequently polytopic ventricular extrasystoles were involved (31.3%), attacks of ventricular tachycardia (20.3%), less frequently bigeminy was recorded (10.9%) and early extrasystoles type R on T (3.1%). As to other disorders of the cardiac rhythm, paroxysmal supraventricular tachycardia was frequent (34.4%), atrial fibrillation or flutter (9.4%) and more numerous supraventricular extrasystoles (7.8%). Sinoatrial (4.7%) and atrioventricular blocks (7.8%) were relatively rare. Examination of patients with hypertrophic cardiomyopathy is an essential prerequisite for the initiation of early and effective treatment which can exert a favourable effect on the subsequent fate of the patients.

[Relation between disorders of cardiac rhythm to the symptomatology and extent of hypertrophic cardiomyopathy]. / Vztah poruch srdecního rytmu k symptomatologii a rozsahu postizení u hypertrofických kardiomyopatií.

The aim of the work was a more detailed characteristic of patients with hypertrophic cardiomyopathy who are threatened by an increased risk of serious disorders of the cardiac rhythm and thus probably also by sudden death. The authors analyzed a group of 64 patients subjected to 24-hour monitoring of the ECG by the Holter system. The patients were subjected to echocardiographic examination and the distribution of the myocardial hypertrophy was described in detail, incl. its extent in per cent of the affected myocardium, the mean thickness of the myocardium (arithmetic mean of the thickness of the left ventricular musculature and septum divided into 10 areas) and the maximum thickness of the heart muscle. The authors found a significantly higher incidence of serious ventricular arrhythmias in patients with an extensive area of the hypertrophy and a greater thickness of the hypertrophic myocardium. In subjects with a positive history of syncopes there was a high incidence of serious supraventricular and ventricular disorders as well as ventricular disorders of the cardiac rhythm. No relationship was found between the incidence of arrhythmias and the presence or size of obstruction. Patients with extensive hypertrophy (i.e. an extensive area of hypertrophy and thickness of the myocardium) and patients with a history of syncopes form thus as regards life-threatening arrhythmias a risk group which after diagnosis should be without delay examined by the Holter system and then treated by medicamentous therapy.