84 results on '"L Janousek"'
Search Results
2. First-in-human Study With LIS1, a Next-generation Porcine Low Immunogenicity Antilymphocyte Immunoglobulin in Kidney Transplantation.
- Author
-
Viklicky O, Slatinska J, Janousek L, Rousse J, Royer PJ, Toutain PL, Cozzi E, Galli C, Evanno G, Duvaux O, Bach JM, Soulillou JP, Giral M, Vanhove B, and Blancho G
- Subjects
- Humans, Animals, Male, Middle Aged, Swine, Female, Adult, T-Lymphocytes immunology, T-Lymphocytes drug effects, Lymphocyte Depletion methods, Graft Rejection immunology, Graft Rejection prevention & control, Immunosuppressive Agents administration & dosage, Immunosuppressive Agents therapeutic use, Treatment Outcome, Galactosyltransferases, Kidney Transplantation adverse effects, Antilymphocyte Serum immunology
- Abstract
Background: Polyclonal rabbit antithymocyte globulins (ATGs) are commonly used in organ transplantation as induction. Anti- N -glycolylneuraminic acid carbohydrate antibodies which develop in response to rabbit carbohydrate antigens might lead to unwanted systemic inflammation. LIS1, the first new generation of antilymphocyte globulins (ALGs) derived from double knockout swine, lacking carbohydrate xenoantigens was already tested in nonhuman primates and rodent models., Methods: This open-label, single-site, dose escalation, first-in-human, phase 1 study evaluated the safety, T cell depletion, pharmacokinetics, and pharmacodynamics of LIS1. In an ascending dose cohort (n = 5), a primary kidney transplant recipient at low immunologic risk (panel reactive antibody [PRA] < 20%), received LIS1 for 5 d at either 0.6, 1, 3, 6, or 8 mg/kg. After each patient completed treatment, the data safety monitoring board approved respective dose escalation. In the therapeutic dose cohort (n = 5) in patients with PRA <50% without donor specific antibodies, 2 patients received 8 mg/kg and 3 patients 10 mg/kg., Results: CD3 + T cell depletion <100/mm 3 at day 2 was observed in all patients who received 6, 8, and 10 mg/kg of LIS1. The terminal half-life of LIS1 was 33.7 d with linearity in its disposition. Lymphocyte repopulation was fast and pretransplant lymphocyte subpopulation counts recovered within 2-4 wk. LIS1 was well tolerated, neither cytokine release syndrome nor severe thrombocytopenia or leukopenia were noticed. Antibodies to LIS1 were not detected., Conclusions: In this first-in-human trial, genome-edited swine-derived polyclonal LIS1 ALG was well tolerated, did not elicit antidrug antibodies, and caused time-limited T cell depletion in low- and medium-risk kidney transplant recipients., Competing Interests: J.R., P.-J.R., G.E., O.D., and B.V. are employees of Xenothera. O.D., J.-P.S., J.-M.B., and C.G. are cofounders of Xenothera. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
3. First-in-human Study With LIS1, a Next-generation Porcine Low Immunogenicity Antilymphocyte Immunoglobulin in Kidney Transplantation.
- Author
-
Viklicky O, Slatinska J, Janousek L, Rousse J, Royer PJ, Toutain PL, Cozzi E, Galli C, Evanno G, Duvaux O, Bach JM, Soulillou JP, Giral M, Vanhove B, and Blancho G
- Subjects
- Humans, Animals, Male, Middle Aged, Swine, Female, Adult, T-Lymphocytes immunology, T-Lymphocytes drug effects, Lymphocyte Depletion methods, Graft Rejection immunology, Graft Rejection prevention & control, Immunosuppressive Agents administration & dosage, Immunosuppressive Agents therapeutic use, Treatment Outcome, Galactosyltransferases, Kidney Transplantation adverse effects, Antilymphocyte Serum immunology
- Abstract
Background: Polyclonal rabbit antithymocyte globulins (ATGs) are commonly used in organ transplantation as induction. Anti- N -glycolylneuraminic acid carbohydrate antibodies which develop in response to rabbit carbohydrate antigens might lead to unwanted systemic inflammation. LIS1, the first new generation of antilymphocyte globulins (ALGs) derived from double knockout swine, lacking carbohydrate xenoantigens was already tested in nonhuman primates and rodent models., Methods: This open-label, single-site, dose escalation, first-in-human, phase 1 study evaluated the safety, T cell depletion, pharmacokinetics, and pharmacodynamics of LIS1. In an ascending dose cohort (n = 5), a primary kidney transplant recipient at low immunologic risk (panel reactive antibody [PRA] < 20%), received LIS1 for 5 d at either 0.6, 1, 3, 6, or 8 mg/kg. After each patient completed treatment, the data safety monitoring board approved respective dose escalation. In the therapeutic dose cohort (n = 5) in patients with PRA <50% without donor specific antibodies, 2 patients received 8 mg/kg and 3 patients 10 mg/kg., Results: CD3 + T cell depletion <100/mm 3 at day 2 was observed in all patients who received 6, 8, and 10 mg/kg of LIS1. The terminal half-life of LIS1 was 33.7 d with linearity in its disposition. Lymphocyte repopulation was fast and pretransplant lymphocyte subpopulation counts recovered within 2-4 wk. LIS1 was well tolerated, neither cytokine release syndrome nor severe thrombocytopenia or leukopenia were noticed. Antibodies to LIS1 were not detected., Conclusions: In this first-in-human trial, genome-edited swine-derived polyclonal LIS1 ALG was well tolerated, did not elicit antidrug antibodies, and caused time-limited T cell depletion in low- and medium-risk kidney transplant recipients., Competing Interests: J.R., P.-J.R., G.E., O.D., and B.V. are employees of Xenothera. O.D., J.-P.S., J.-M.B., and C.G. are cofounders of Xenothera. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
4. Open revascularization in a patient with chronic mesenteric ischemia and a history of aorto-bifemoral bypass - a case report.
- Author
-
Olexa M, Lipár K, Chlupac J, Janousek L, and Froněk J
- Subjects
- Male, Humans, Treatment Outcome, Vascular Surgical Procedures, Intestines, Ischemia etiology, Ischemia surgery, Chronic Disease, Mesenteric Ischemia surgery, Mesenteric Vascular Occlusion surgery
- Abstract
Introduction: This case report describes surgical treatment of chronic mesenteric ischemia in a polymorbid patient with the history of an aorto-bifemoral bypass implant., Case Report: The patient suffered from chronic occlusions of the mesenteric arteries. He experienced postprandial pain and significant weight loss. Endovascular repair of the occlusions failed. Open single retrograde bypass from the left branch of the aorto-bifemoral graft to the superior mesenteric artery was implanted successfully., Conclusion: The discussion briefly mentions current trends in the treatment of chronic mesenteric ischemia. Despite the development of interventional radiology, surgical treatment remains a relevant alternative for the management of chronic mesenteric ischemia.
- Published
- 2023
- Full Text
- View/download PDF
5. Retroperitoneal tumour resection in fifteen consecutive cases: Single centre experience.
- Author
-
Novotný R, Donátová Z, Büchler T, Kristek J, Froněk J, and Janousek L
- Subjects
- Adult, Male, Humans, Female, Retroperitoneal Space pathology, Retrospective Studies, Retroperitoneal Neoplasms surgery, Retroperitoneal Neoplasms pathology, Retroperitoneal Neoplasms secondary, Testicular Neoplasms pathology, Testicular Neoplasms surgery, Neoplasms, Germ Cell and Embryonal
- Abstract
Introduction: Retroperitoneal tumours (RTs) in adults are a rare heterogeneous group of neoplasms arising from the retroperitoneal space. RTs'clinical manifestations are nonspecific and depend on their anatomical positioning and relation with bordering structures. Our study aimed to retrospectively evaluate our patients' diagnosis, length of hospital stay, disease-free period and postoperative metastasis occurrence., Methods: From 2011 to 2019, fifteen suspected RT resections were performed at our centre. Retrospective analysis of patients' hospital stays, follow-up, histological and immunological tumour profile, and metastasis occurrence/ re-occurrence was performed., Result: All of the 15 (100%) patients were males. The average age of our patients was 44 years (SD ± 11.2 years), average hospital stay was 7.4 days (SD±3.4 days) (Tab.1). All resected tumours underwent histological and immunological evaluation. Based on histological examination of the resected tumours, nonseminomatous germ cell tumours were present in 12 (80%) patients - including teratoma in 4 (26.6%) patients, seminoma in 2 (13.3%) patients, and malignant B-cell lymphoma in 1 (6.6%) patient. The average patient follow-up was 42.7 months (SD±31.4.9 months). Complete remission after the surgery was achieved in 11 (76.9%) patients, and 2 (13.3%) patients were lost in follow-up., Conclusion: RT is a rare heterogeneous group of neoplasm. The patient's prognosis dramatically depends on the type of tumour, metastasis occurrence and re-occurrence, and the surgeons' ability to resect the tumour completely.
- Published
- 2023
- Full Text
- View/download PDF
6. Fresh arterial allograft as a replacement for an infected common femoral prosthetic graft and recurrent false aneurysm.
- Author
-
Pluchova M, Chlupac J, Janousek L, and Froněk J
- Subjects
- Male, Humans, Aged, Blood Vessel Prosthesis adverse effects, Arteries transplantation, Allografts surgery, Femoral Artery surgery, Treatment Outcome, Retrospective Studies, Reoperation adverse effects, Aneurysm, False surgery, Aneurysm, False complications, Prosthesis-Related Infections surgery, Prosthesis-Related Infections microbiology, Blood Vessel Prosthesis Implantation
- Abstract
Replacing an infected vascular prosthetic conduit with an allograft is a possible solution of this complication given the low recurrence of infection. It is most commonly utilized for cases where the use of autologous tissue is not an option. We present the case of a 70-year-old patient who had undergone repeated vascular reconstructions in the right lower limb. He was admitted to our department due to a progressively growing mass in the right groin and subsequently placed on the waiting list for a fresh allograft. The patient had the infected false aneurysm and prosthetic material of the femoral bifurcation replaced with an arterial allograft. The previous femoral popliteal autovenous bypass graft was reimplanted into the allograft. There were signs of sepsis during the operation; however, the blood culture was negative. Cultures from neither the wound nor the drain revealed the presence of any bacteria. The patient was discharged on the seventh post-operative day with prophylactic antibiotics. An early followup confirmed that there were no signs of recurrent infection and that the reconstruction remained patent. Seven and half months after the surgery, the femoral popliteal bypass graft became occluded and a conservative approach was chosen. A small thrombosed false aneurysm of the graft was revealed two years after the surgery due to transient non-compliance of the patient to immunosuppression therapy. It was treated conservatively. Two and a half years after the surgery, the allograft still remains open and the limb is preserved.
- Published
- 2023
- Full Text
- View/download PDF
7. Early Uterine Transplant Graft Loss Due to Thrombosis: Single-Center Experience With Causes, Prevention, Diagnosis, and Treatment.
- Author
-
Kristek J, Sticova E, Chlupac J, Cermakova H, Maluskova J, Janousek L, Olausson M, and Fronek J
- Subjects
- Humans, Female, Uterus transplantation, Tissue Donors, Fibrosis, Thrombosis etiology, Thrombosis prevention & control, Transplants
- Abstract
Uterus transplantation (UTx) is a promising treatment option for women who wish to give birth but suffer from absolute uterine factor infertility. This paper presents an interim analysis of a trial focusing on the causes, prevention, diagnosis, and management of graft thrombosis. Our team analyzed 10 cases of UTx (recipients numbered 1 to 10). Early thrombosis developed in 2 of 10 (20 %) recipients, and thrombectomy and temporary viability preservation were achieved in both cases. However, re-thrombosis developed in both cases, and a graft hysterectomy was carried out. In recipient number 2, vascular changes might have contributed to graft thrombosis. The histopathological finding of the explant revealed subintimal excentric fibrosis with focal sclerotic changes. In recipient number 8, thrombosis was facilitated by external compression of the vascular pedicles by the hematoma as well as production of de novo donor-specific antibodies. Thrombosis led to graft loss in both cases despite an attempt at a thrombectomy. Therefore, the focus must be on prevention including a thorough evaluation of the donor candidate. In the postoperative course, perfusion is closely followed-up with an ultrasound, Doppler flow monitoring, and macroscopic evaluation of the cervix. In the event that findings are unclear, a relaparotomy should be promptly indicated. If thrombosis is revealed, a thrombectomy and an attempt to salvage the graft are indicated; however, the role of this strategy is questionable due to the low chance of long-term success. The indication of upfront graft removal and early re-transplantation in the treatment of uterine graft remains debatable.
- Published
- 2022
8. Links between macrophages in perivascular adipose tissue and arterial wall: a role in atherosclerosis initiation?
- Author
-
Bartuskova H, Kauerova S, Petras M, Poledne R, Fronek J, Janousek L, and Kralova Lesna I
- Subjects
- Humans, Cross-Sectional Studies, Macrophages, Adipose Tissue, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atherosclerosis
- Abstract
Background: Inflammation of adipose tissue in relation to atherosclerosis is currently widely studied in patients with advanced disease. However, data regarding polarization of adipose tissue and arterial wall macrophages and their mutual link in the early stages of atherosclerosis are scarce. The main aim of this cross-sectional study was to characterize macrophage subpopulations in arterial wall and adjacent adipose tissue; and to determine links between different subpopulations in a relatively healthy population living kidney donors., Methods: The presence of cardiovascular risk factors was established in 68 living kidney donors. Macrophage polarization was analyzed by flow cytometry and confirmed by RT-PCR in samples of visceral adipose tissue, renal artery and adjacent perivascular adipose tissue collected during hand-assisted retroperitoneoscopic nephrectomy., Results: CD14+CD16+CD36
high macrophages were found only in adipose tissues and were strongly positively associated with several cardiovascular risk factors. The CD14+CD16+CD36low subpopulation was positively associated with the presence of several cardiovascular risk factors to a lesser extent in all studied tissues. In contrast, the proportion of CD14+CD16-CD36low macrophages was negatively linked to several cardiovascular risk factors and increased in subjects on statin therapy. The proportion of CD14+CD16+CD36low macrophages in perivascular, not visceral adipose tissue was associated with that of both macrophage subtypes in the arterial wall, suggesting a direct link between perivascular adipose tissue and the arterial wall., Conclusions: We confirmed the association of three macrophage subtypes in adipose tissue and arterial wall to the studied cardiovascular risk factors. Macrophage polarization in perivascular, but not visceral adipose tissue was linked to macrophage polarization in the arterial wall.- Published
- 2022
- Full Text
- View/download PDF
9. Machine learning-based improvement of an online rheumatology referral and triage system.
- Author
-
Knitza J, Janousek L, Kluge F, von der Decken CB, Kleinert S, Vorbrüggen W, Kleyer A, Simon D, Hueber AJ, Muehlensiepen F, Vuillerme N, Schett G, Eskofier BM, Welcker M, and Bartz-Bazzanella P
- Abstract
Introduction: Rheport is an online rheumatology referral system allowing automatic appointment triaging of new rheumatology patient referrals according to the respective probability of an inflammatory rheumatic disease (IRD). Previous research reported that Rheport was well accepted among IRD patients. Its accuracy was, however, limited, currently being based on an expert-based weighted sum score. This study aimed to evaluate whether machine learning (ML) models could improve this limited accuracy., Materials and Methods: Data from a national rheumatology registry (RHADAR) was used to train and test nine different ML models to correctly classify IRD patients. Diagnostic performance was compared of ML models and the current algorithm was compared using the area under the receiver operating curve (AUROC). Feature importance was investigated using shapley additive explanation (SHAP)., Results: A complete data set of 2265 patients was used to train and test ML models. 30.5% of patients were diagnosed with an IRD, 69.3% were female. The diagnostic accuracy of the current Rheport algorithm (AUROC of 0.534) could be improved with all ML models, (AUROC ranging between 0.630 and 0.737). Targeting a sensitivity of 90%, the logistic regression model could double current specificity (17% vs. 33%). Finger joint pain, inflammatory marker levels, psoriasis, symptom duration and female sex were the five most important features of the best performing logistic regression model for IRD classification., Conclusion: In summary, ML could improve the accuracy of a currently used rheumatology online referral system. Including further laboratory parameters and enabling individual feature importance adaption could increase accuracy and lead to broader usage., Competing Interests: Qinum and RheumaDatenRhePort developed and hold rights for Rheport. WV, CD, and PB-B were involved in the development of Rheport. JK was a member of the scientific board of RheumaDatenRhePort. WV, CD, SK, PB-B, and MW were members of RheumaDatenRhePort GbR. RHADAR GbR received honoraria from UCB Pharma GmbH, Sandoz Deutschland/Hexal AG, Lilly GmbH, and Galapagos Biopharma Germany GmbH, and research support from Novartis Pharma GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Knitza, Janousek, Kluge, von der Decken, Kleinert, Vorbrüggen, Kleyer, Simon, Hueber, Muehlensiepen, Vuillerme, Schett, Eskofier, Welcker and Bartz-Bazzanella.)
- Published
- 2022
- Full Text
- View/download PDF
10. Giant aggressive intra-abdominal desmoid-type fibromatosis - case report.
- Author
-
Novotný R, Mendl J, Kocík M, Kristek J, Froněk J, and Janousek L
- Subjects
- Aged, Humans, Laparotomy, Male, Mesentery surgery, Tomography, X-Ray Computed, Abdominal Wall surgery, Fibromatosis, Aggressive diagnostic imaging, Fibromatosis, Aggressive surgery
- Abstract
Introduction: Aggressive fibromatosis, also known as desmoid tumour (DT), is a locally invasive soft tissue malignancy originating from fascial planes, connective tissue, and musculoaponeurotic structures of the muscles. The symptoms greatly depend on the location and size of the tumour., Case Report: A 68-year-old male patient without any comorbidities with a large, palpable mass in the abdomen underwent computed tomography (CT) of the abdomen during diagnostic examination in September 2017 in another centre. The CT scan revealed a giant intraperitoneal 30×40cm tumour without signs of infiltrating the surrounding organs and large vessels. The tumour biopsy revealed an aggressive DT. The patient was scheduled for tumour resection. Midline laparotomy was performed in the supine position under general anaesthesia. After gaining access to the abdominal cavity, 8 litres of clear ascites were evacuated. The tumour was not attached to the abdominal wall. Large omentum was freed from the DT. The perioperative finding confirmed the CT images of DT encapsulation of the medial colic artery, part of the small intestine, and transverse colon. The tumour was resected with part of the mesenteric radix, 30 cm of small intestine, and 2/3 of the transverse colon. After the DT was removed entirely, the small intestine was re-anastomosed end to end. The abdominal cavity and the liver were carefully checked for bleeding. The abdominal cavity was closed in a standard manner., Results: The postoperative hospital stay was uneventful. The patient was discharged on the 7th postoperative day with prophylactic low weight molecular heparin for one month. Currently, we have five months of follow-up with no signs of DT recurrence based on CT examination. The histology of the resected tumour confirmed the diagnosis of a desmoid tumour (aggressive abdominal fibromatosis)., Conclusion: Desmoid tumours are benign neoplasms with no metastatic potential. However, their treatment is challenging due to their aggressive growth, infiltrative behaviour, and a high tendency to recur.
- Published
- 2022
- Full Text
- View/download PDF
11. Biliary obstruction following transjugular intrahepatic portosystemic shunt placement in a patient after liver transplantation: A case report.
- Author
-
Macinga P, Gogova D, Raupach J, Jarosova J, Janousek L, Honsova E, Taimr P, Spicak J, Novotny J, Peregrin J, and Hucl T
- Abstract
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a method used to decrease portal hypertension. Biliary stricture is the rarest of the complications associated with this procedure with only 12 cases previously reported in the literature. None of these cases have documented the resolution of biliary stenosis induced by a stent graft. The only curative solutions reported are liver transplantation or bypassing the stenosis with an artificial biliary tract using advanced endoscopic techniques., Case Summary: This is the first reported case of biliary obstruction secondary to TIPS placement in a transplanted liver. In our patient, a portosystemic shunt was created to treat severe veno-occlusive liver graft disease manifesting itself primarily by fluid retention. A cholestatic liver lesion and cholangitis with abscesses developed due to a stent graft-induced stricture in the dorsal segment of the right hepatic duct and the stricture diminished following percutaneous drainage. Endoscopic drainage was performed after unsuccessful removal of the percutaneous catheter resulting in a bilio-cutaneous fistula. Although the liver graft now functions well, the stricture remains refractory even after 44 mo of treatment., Conclusion: Biliary strictures caused by TIPS in both transplanted and native livers seem refractory to endoscopic treatment., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
12. Thrombolysis as a treatment for transplant renal artery thrombosis - a report of three unsuccessful cases and an overview of reported cases.
- Author
-
Kristek J, Tavlaridis M, Novotný R, Janousek R, Janousek L, Maluskova J, Peregrin JH, Chlupac J, Kachlík D, and Froněk J
- Subjects
- Humans, Retrospective Studies, Thrombolytic Therapy, Treatment Outcome, Renal Artery, Thrombosis diagnostic imaging, Thrombosis drug therapy, Thrombosis etiology
- Abstract
Introduction: Thrombolysis has been suggested as a feasible method to treat arterial renal transplant thrombosis under conditions of short duration of ischemia. Data on maximal duration of ischemia that are still feasible to treat are scarce., Methods: We retrospectively analysed our experience involving three attempts to utilize thrombolysis to treat transplant renal artery thrombosis. We searched through literature on PubMed and compared the data we found with our own experience., Results: In case number 1 of our cohort, thrombolysis was initiated 12 hours after the onset of thrombosis and had to be ceased after five hours due to the formation of a haematoma. Perfusion of the graft was restored but it did not regain function, most likely due to long ischemia time. In case number 2, an attempt to use thrombolysis was unsuccessful due to failure to cross the graft artery occlusion with a guidewire. Thrombosis was most likely caused by chronic rejection of the graft. In case number 3, thrombolysis restored arterial patency but, due to an onset of ischemia, which lasted 2 to 3 days, did not lead to restoration of graft function. The prolonged ischemia period in case three occurred, at least in part, due to failure to perform an ultrasound scan when the patient was first admitted., Conclusion: We can confirm that thrombolysis for transplant renal artery thrombosis seems to be feasible only when the condition has a short duration. In the event of sudden deterioration of graft function, the absence of perfusion must always be ruled out by ultrasound scan.
- Published
- 2021
- Full Text
- View/download PDF
13. Live Birth Following Uterine Transplantation From a Nulliparous Deceased Donor.
- Author
-
Fronek J, Janousek L, Kristek J, Chlupac J, Pluta M, Novotny R, Maluskova J, and Olausson M
- Subjects
- 46, XX Disorders of Sex Development complications, Adult, Congenital Abnormalities, Donor Selection, Female, Humans, Infertility, Female diagnosis, Infertility, Female etiology, Infertility, Female physiopathology, Live Birth, Mullerian Ducts abnormalities, Postoperative Complications etiology, Postoperative Complications therapy, Pregnancy, Reproductive Techniques, Assisted, Stents, Time-to-Pregnancy, Treatment Outcome, Young Adult, Fertility, Infertility, Female surgery, Parity, Tissue Donors, Uterus transplantation
- Abstract
Background: Nulliparous uterine grafts have never been used in uterus transplantation (UTx), possibly due to presumed infertility. Our objective was to verify the feasibility of nulliparous uterine graft transplantation., Methods: The Czech Uterus Transplant Trial (registered under ClinicalTrials.gov, identifier NCT03277430) is a 2-arm trial comparing the efficacy of deceased donor (DD) versus live-donor uterus transplant (10 patients in both arms). A 25-year-old patient suffering from inborn absolute uterine factor infertility underwent a DD uterus transplant. The donor was a 20-year-old nulliparous brain-dead donor., Results: The transplant procedure was uneventful. The posttransplant period was complicated by (1) recurrent episodes of acute cellular rejection, (2) neutropenia necessitating the administration of granulocyte colony-stimulating factor, (3) vaginal anastomotic stenosis treated with the insertion of a self-expanding stent, (4) the concurrence of Clostridium difficile colitis and acute appendicitis, and (5) temporary renal function impairment of a combined cause. Two years after the UTx, after the fourth embryo transfer, the patient became pregnant. Apart from gestational diabetes mellitus, the pregnancy was uneventful. Due to preterm contractions, delivery was achieved via caesarean section at gestational age 34 + 6 years. The postoperative course was uneventful for both the mother and the newborn., Conclusions: Herein, we report the first live birth after a DD UTx in Europe. This report provides a proof of concept that nulliparous uteri may present a suitable source of uterine grafts for UTx. Stenting may serve as a feasible treatment method for vaginal anastomotic stenosis., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
14. Statins Directly Influence the Polarization of Adipose Tissue Macrophages: A Role in Chronic Inflammation.
- Author
-
Kauerova S, Bartuskova H, Muffova B, Janousek L, Fronek J, Petras M, Poledne R, and Kralova Lesna I
- Abstract
Statins represent one of the most widely used classes of drugs in current medicine. In addition to a substantial decrease in atherogenic low density lipoprotein (LDL) particle concentrations, several large trials have documented their potent anti-inflammatory activity. Based on our preliminary data, we showed that statins are able to decrease the proportion of pro-inflammatory macrophages (CD14+16+CD36high) in visceral adipose tissue in humans. In the present study including 118 healthy individuals (living kidney donors), a very close relationship between the pro-inflammatory macrophage proportion and LDL cholesterol levels was found. This was confirmed after adjustment for the most important risk factors. The effect of statins on the proportion of pro-inflammatory macrophages was also confirmed in an experimental model of the Prague hereditary hypercholesterolemia rat. A direct anti-inflammatory effect of fluvastatin on human macrophage polarization in vitro was documented. Based on modifying the LDL cholesterol concentrations, statins are suggested to decrease the cholesterol inflow through the lipid raft of macrophages in adipose tissue and hypercholesterolemia to enhance the pro-inflammatory macrophage phenotype polarization. On the contrary, due to their opposite effect, statins respond with anti-inflammatory activity, affecting the whole organism.
- Published
- 2021
- Full Text
- View/download PDF
15. Human Uterus Transplantation from Living and Deceased Donors: The Interim Results of the First 10 Cases of the Czech Trial.
- Author
-
Fronek J, Kristek J, Chlupac J, Janousek L, and Olausson M
- Abstract
Introduction: Uterus transplantation (UTx) is a rapidly evolving treatment of uterine-factor infertility. We report the results of the first 10 UTx procedures performed at our institution., Methods: The program started in April 2016 as a two-arm study comparing the efficacy of UTx from live donors (LD) and deceased donors (DD)., Results: Between April 2016 and April 2018, we performed five DD UTx and five LD UTx. Two grafts had to be removed early due to thrombosis. One graft was removed due to chronic rejection and previous herpes simplex infection at month 7. Graft survival is 70% at one year. Recipient survival is 100% at two years. Live donor survival is 100% at three years. Three live-births have been achieved, two from a LD and one from a graft from a nulliparous DD. Vaginal anastomotic stenosis occurred in 63% (5/8) of grafts. Self-expanding stents have shown preliminary suitability for the treatment of vaginal stenosis. Three recipients developed severe acute rejection., Conclusion: The interim results of our study demonstrate mid-term viability in 70% of grafts. The LD UTx produced two live births and the DD UTx produced one live birth. Nulliparous donors should be considered for donation.
- Published
- 2021
- Full Text
- View/download PDF
16. The relationship between lower urinary tract dysfunctions and urinary leakage from ureterocystoneoanastomosis in male patients after kidney transplantation.
- Author
-
Zachoval R, Krhut J, Slatinska J, Viklicky O, and Janousek L
- Subjects
- Cohort Studies, Humans, Male, Urodynamics, Kidney Transplantation adverse effects, Urinary Bladder Neck Obstruction
- Abstract
Objectives: The aim of this study was to investigate the association of lower urinary tract dysfunctions with urinary leakage from ureterocystoneoanastomosis (UCNA) after kidney transplantation., Background: The UCNA leakage after kidney transplantation can be associated with various conditions while severe lower urinary tract dysfunctions could be one of them., Methods: The analysis included all men who underwent kidney transplantation between January 2009 and December 2014. The parameters of storage and voiding functions were evaluated. All patients were monitored during their post-transplantation period for the incidence of urinary leakage from UCNA. Urodynamic parameters were compared between men with and without a documented leakage., Results: The study cohort included 127 male patients, while UCNA leakage was observed in 11 (8.7 %) patients. Significant differences between both groups of patients were found for storage parameters (patients with leakage had smaller volume at first and a normal desire to void, smaller maximal cystometric capacity, and lower detrusor compliance) and voiding parameters (patients with leakage had a lower maximal flow rate, higher detrusor pressure at maximal flow rate and higher bladder outlet obstruction index)., Conclusion: This study shows an association between lower urinary tract dysfunction and UCNA leakage in men without previous urological history (Tab. 2, Fig. 2, Ref. 24). Text in PDF www.elis.sk Keywords: urinary leakage, ureterocystoneoanastomosis, lower urinary tract dysfunctions, kidney transplantation.
- Published
- 2021
- Full Text
- View/download PDF
17. NIRS-based monitoring of kidney graft perfusion.
- Author
-
Maly S, Janousek L, Bortel R, Sebek J, Hospodka J, Skapa J, and Fronek J
- Subjects
- Animals, Early Diagnosis, Kidney diagnostic imaging, Models, Animal, Renal Circulation, Sensitivity and Specificity, Spectroscopy, Near-Infrared, Swine, Vascular Diseases etiology, Kidney blood supply, Kidney Transplantation adverse effects, Vascular Diseases diagnosis
- Abstract
Introduction: Acute early vascular complications are rare, but serious complications after kidney transplantation. They often result in graft loss. For this reason, shortening the diagnostic process is crucial. Currently, it is standard procedure to monitor renal graft perfusion using Doppler ultrasound (DU). With respect to acute vascular complications, the main disadvantage of this type of examination is its periodicity. It would be of great benefit if graft blood perfusion could be monitored continuously during the early postoperative period. It appears evident that a well-designed near infrared spectroscopy (NIRS) monitoring system could prove very useful during the early post-transplantation period. Its role in the immediate diagnosis of vascular complications could result in a significant increase in graft salvage, thus improving the patient's overall quality of life and lowering morbidity and mortality for renal graft recipients. The aim of this study was to design, construct and test such a monitoring system., Materials and Methods: We designed a rough NIRS-based system prototype and prepared a two-stage laboratory experiment based on a laboratory pig model. In the first stage, a total of 10 animals were used to verify and optimize the technical aspects and functionality of the prototype sensor by testing it on the animal kidneys in-vivo. As a result of these tests, a more specific prototype was designed. During the second stage, we prepared a unique laboratory model of a pig kidney autotransplantation and tested the system for long-term functionality on a group of 20 animals. Overall sensitivity and specificity were calculated, and a final prototype was prepared and completed with its own analytic software and chassis., Results: We designed and constructed a NIRS-based system for kidney graft perfusion monitoring. The measurement system provided reliable performance and 100% sensitivity when detecting acute diminished blood perfusion of the transplanted kidneys in laboratory conditions., Conclusion: The system appears to be a useful tool for diagnosing diminished blood perfusion of kidney transplants during the early postoperative period. However, further testing is still required. We believe that applying our method in current human transplantation medicine is feasible, and we are confident that our prototype is ready for human testing., Competing Interests: No competing interests.
- Published
- 2020
- Full Text
- View/download PDF
18. Hybrid Repair Combined with Fresh Arterial Allograft Extra-Anatomical Reconstruction: The Treatment of Infrarenal Abdominal Aneurysm above an Aortobifemoral Bypass Complicated by an Infected Pseudoaneurysm in the Left Groin.
- Author
-
Novotny R, Marada T, Novotny J, Kristek J, Chlupac J, Kudla M, Lipar K, Mendl J, Fronek J, and Janousek L
- Abstract
Introduction: A 72-year-old male patient was admitted into our centre with large infected pseudoaneurysm (PSA) in the left groin. The patient underwent a CT angiography (CTA) that confirmed a large partly thrombosed 6.5 × 5.5 cm PSA in the left groin arising from the distal anastomosis of the aortobifemoral bypass (ABF). Furthermore, the CTA revealed 11 cm juxtarenal abdominal aortic aneurysm (JAAA) from which the proximal anastomosis of the ABF was arising., Method: Aorto-uni-iliac stent graft Cook was placed from the right groin trough native severely stenotic right iliac arteries with proximal landing zone below the renal arteries, excluding the JAAA and the ABF. The distal landing zone was in the common iliac artery maintaining patent right internal iliac artery. Afterwards, a femoro-femoral crossover bypass from right to left was performed using a fresh arterial allograft. Postprocedurally, the hospital stay was uneventful. The left groin PSA cultures came positive for S taphylococcus epidermidis and Corynebacterium tuberculostearicum , both sensitive to vancomycin and rifampicin., Result: The patient underwent intravenous ATB treatment with vancomycin for two weeks, followed by four weeks of oral rifampicin. The patient was discharged on the 20
th postoperative days., Conclusion: Hybrid repair combining aortic stent graft and extra-anatomical bypass in the treatment of infected distal parts of an aortofemoral bypass is an acceptable treatment modality., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this article., (Copyright © 2020 Robert Novotny et al.)- Published
- 2020
- Full Text
- View/download PDF
19. The Effect of Different Thawing Rates on Cryopreserved Human Iliac Arteries Allograft's Structural Damage and Mechanical Properties.
- Author
-
Novotny R, Mericka P, Chlupac J, Matejka R, Kristek J, Marada T, Konarik M, Ivak P, Sterba L, Hlubocky J, Pirk J, Janousek L, and Fronek J
- Subjects
- Adult, Allografts drug effects, Cryoprotective Agents pharmacology, Dimethyl Sulfoxide pharmacology, Female, Humans, Iliac Artery drug effects, Male, Middle Aged, Allografts physiology, Cryopreservation methods, Iliac Artery physiology
- Abstract
Introduction: The rate of thawing of cryopreserved human iliac arteries allografts (CHIAA) directly affects the severeness of structural changes that occur during this process., Method: The experiment was performed on ten CHIAA. The 10% dimethylsulphoxide in 6% hydroxyethyl starch solution was used as the cryoprotectant; all CHIAA were cooled at a controlled rate and stored in the vapor phase of liquid nitrogen (-194°C). Two thawing protocols were tested: (1) placing the CHIAA in a water bath at 37°C, and (2) the CHIAA were thawed in a controlled environment at 5°C. All samples underwent analysis under a scanning electron microscope. Testing of the mechanical properties of the CHIAA was evaluated on a custom-built single axis strain testing machine. Longitudinal and circumferential samples were prepared from each tested CHIAA., Results: Ultrastructural analysis revealed that all five CHIAA thawed during the thawing protocol 1 which showed significantly more damage to the subendothelial structures when compared to the samples thawed in protocol 2. Mechanical properties: Thawing protocol 1-longitudinal UTS 2, 53 ± 0, 47 MPa at relative strain 1, 27 ± 0, 12 and circumferential UTS 1, 94 ± 0, 27 MPa at relative strain 1, 33 ± 0, 09. Thawing protocol 2-longitudinal ultimate tensile strain (UTS) 2, 42 ± 0, 34 MPa at relative strain 1, 32 ± 0, 09 and circumferential UTS 1, 98 ± 0, 26 MPa at relative strain 1, 29 ± 0, 07. Comparing UTS showed no statistical difference between thawing methods., Conclusion: Despite the significant differences in structural changes of presented thawing protocols, the ultimate tensile strain showed no statistical difference between thawing methods., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this article., (Copyright © 2020 Robert Novotny et al.)
- Published
- 2020
- Full Text
- View/download PDF
20. New Proposal for Inverse Algorithm Enhancing Noise Robust Eddy-Current Non-Destructive Evaluation.
- Author
-
Smetana M, Behun L, Gombarska D, and Janousek L
- Abstract
Solution of inverse problem in eddy-current non-destructive evaluation of material defects is concerned in this study. A new inverse algorithm incorporating three methods is proposed. The wavelet transform of sensed eddy-current responses complemented by the principal component analysis and followed by the neural network classification are employed for this purpose. The goal is to increase the noise robustness of the evaluation. The proposed inverse algorithm is tested using real eddy-current response data gained from artificial electro-discharge machined notches made in austenitic stainless-steel biomaterial. Eddy-current responses due to the material defects are acquired using a newly developed eddy-current probe that senses separately three spatial components of the perturbed electromagnetic field. The presented results clearly show that the error in evaluation of material defect depth using the proposed algorithm is less than 10% even when the signal-to-noise ratio is as high as 10 dB.
- Published
- 2020
- Full Text
- View/download PDF
21. Liver transplantation using grafts from donors after circulatory death - the first Czech Republic experience.
- Author
-
Froněk J, Novotný R, Kucera M, Mendl J, Kocík M, Trunecka P, Taimr P, Kieslichová E, Pokorná E, and Janousek L
- Subjects
- Czech Republic, Female, Graft Survival, Humans, Male, Retrospective Studies, Tissue Donors, Liver Transplantation, Tissue and Organ Procurement
- Abstract
Introduction: Liver transplantation is established as a lifesaving procedure for patients with acute and chronic liver failure, as well as certain selected malignancies. Due to a continuing organ shortage and ever-growing patient waiting lists, donation after cardiac death (DCD) is becoming more frequently utilized in order to close the gap between “supply and demand”., Methods: A retrospective analysis of DCD and subsequent liver transplantations was performed., Results: From May 2016 to September 2019, a total of 9 DCD liver transplantations were performed in our institution. All cases except one were primary liver transplantations. The recipients comprised 5 (56%) males and 4 (44%) females. The mean DCD donor age was 41±12 (22-57) years, with ventilation duration of 7±1 days and warm ischemia time 19±3 minutes. The average recipient age was 51±22 (4-73) years, with an average cold ischemia 3h:59m±27m and manipulation time of 23±5 minutes. Periprocedural mortality was 1 (11%). Hepatitis C recurrence was documented in 1 (11%) patient. The mean follow-up time was 19±13 (7-37) months. Until now, we have not observed any signs of ischemic cholangiopathy., Conclusion: DCD liver transplantation allows us to enlarge the pool of potential liver grafts, thus decreasing the time spent on the liver recipient waiting list. This paper documents the first series of DCD liver transplantations in the Czech Republic.
- Published
- 2020
- Full Text
- View/download PDF
22. Radiofrequency electromagnetic field affects heart rate variability in rabbits.
- Author
-
Misek J, Veterník M, Tonhajzerova I, Jakusova V, Janousek L, and Jakus J
- Subjects
- Animals, Arrhythmias, Cardiac pathology, Double-Blind Method, Heart Rate physiology, Models, Animal, Rabbits, Random Allocation, Arrhythmias, Cardiac etiology, Cell Phone instrumentation, Electromagnetic Fields adverse effects, Environmental Exposure adverse effects, Heart Rate radiation effects, Radio Waves adverse effects
- Abstract
The aim of this study was to assess the effects of radiofrequency electromagnetic field (RF EMF) on heart rate variability (HRV) in rabbits with intensity slightly exceeding the limits for occupations. Totally 21 New Zealand white rabbits divided into two groups were used in this double-blind study. The first group of animals without general anesthesia was subjected to HRV examination under exposure to a device generated RF EMF source (frequency 1788 MHz, intensity 160 V/m, lasting 150 min.). The second group (premedications + alpha chloralose mg/kg) underwent the same protocol under the exposure to the real RF EMF signal from the base stations of mobile providers (frequency range 1805 - 1870 MHz - corresponding to the downlink signal of Slovak mobile providers, 160 V/m, 150 min., respectively). Individual 5 min records were used to analyze the HRV parameters: heart rate and root Mean Square of the Successive Differences (rMSSD) for time domain analysis and spectral powers in the low (LF-VFS) and high frequency (HF-VFS) bands for frequency domain analysis. Our study revealed the increased in HRV parameters (HF-HRV, rMSSD) associated with lower heart rate indicating increased cardiac vagal control under the exposure to RF EMF in experimental methods.
- Published
- 2020
- Full Text
- View/download PDF
23. Uterine transplantation in an era of successful childbirths from living and deceased donor uteri: Current challenges.
- Author
-
Chmel R, Pastor Z, Matecha J, Janousek L, Novackova M, and Fronek J
- Subjects
- Czech Republic, Female, Humans, Pregnancy, Pregnancy Outcome, Donor Selection, Infertility, Female surgery, Reproductive Techniques, Assisted, Uterus transplantation
- Abstract
Background and Aims: Uterine transplantation (UTx) is an experimental sterility treatment method in women with absolute uterine factor infertility. This article describes the current trends and risks in UTx and provides an overview of our experience with this method, to date., Methods: Based on our experience with the Czech UTx trial and the published results of other trials, we describe the possibilities and risks of this perspective method in the treatment of absolute uterine factor infertility (AUFI)., Results: Twelve healthy babies were born in 2014-2018 after more than 40 uterine transplantations. There is no general consensus whether it is more suitable to transplant uteri from living or deceased donors, and nulliparous or parous women (with proven obstetrical functionality). Most centers prefer to collect at least ten frozen embryos from in vitro fertilization (IVF) cycles before transplantation. The serious complication of a surgically successful uterine transplantation is posttransplant partial stenosis of the uterine-vaginal anastomosis that may be a technical problem for embryo transfer, outflow of menstrual blood, and sexual satisfaction due to the narrowed and shortened vagina. This paper concludes that, currently, procurement of the uterus and the transplant procedure are surgically feasible and that none of the transplanted uteri have been lost due to rejection but only because of graft thrombosis or infection., Conclusion: Uterine transplantation, after optimization of surgical methods, selection of suitable donors, standardization of immunosuppressive therapy, adjustment of assisted reproductive technologies and obstetrical proceedings might be an effective therapeutic method for women with AUFI who wish to have their own biological child.
- Published
- 2020
- Full Text
- View/download PDF
24. Uterus transplant graft's arterial atherosclerotic remodeling veracity.
- Author
-
Novotny R, Chlupac J, Kristek J, Pit'ha J, Chmel R, Sticova E, Janousek L, and Fronek J
- Subjects
- Female, Humans, Nitric Oxide metabolism, Tunica Intima metabolism, Uterus blood supply, Vascular Remodeling, Atherosclerosis etiology, Uterine Artery, Uterus transplantation, Vascularized Composite Allotransplantation adverse effects
- Abstract
Background: Uterus transplantation is a complex, multi-step experimental procedure used for the treatment of uterus absence or uterus anomaly that prevents embryo implantation or pregnancy completion., Method: To date, only 51 uterus transplants worldwide had been performed. When simplified, it is vascularized composite allograft transplantation. While it is still an experimental procedure with encouraging results for the future, there are still many issues that have to be clarified. The most serious complications of uterus transplantation are graft rejection or grafts vascular failure., Results: So far, no reference to the atherosclerotic arterial infiltration of the uterus arteries was suggested and studied as one of the main causes of graft's failure., Conclusion: In this review we summarized current knowledge and possible role of uterus arterial damage, including atherosclerotic changes on the graft's survival.
- Published
- 2020
- Full Text
- View/download PDF
25. Acute appendicitis in a patient after a uterus transplant: A case report.
- Author
-
Kristek J, Kudla M, Chlupac J, Novotny R, Mirejovsky T, Janousek L, and Fronek J
- Abstract
Background: Acute appendicitis in a solid organ transplant recipient is a rare occurrence, and experience remains limited. Appendicitis in uterine transplant recipients has never been reported. Immunocompromised patients with acute abdomen often present late and with attenuated symptoms. The differential diagnosis in a transplanted patient is broad and challenging due to possible existing complications associated with the graft, effects of immunosuppression, and altered anatomical relations., Case Summary: A 26-year-old woman suffering from absolute uterine factor infertility received a uterus transplant. In the post-transplant period, she suffered from leukopenia and recurrent acute cellular rejection. Her compliance was suboptimal. She travelled to an exotic destination despite the physician's recommendation not to do so. Following her vacation, she presented with abdominal discomfort, nausea and diarrhoea. There was no sign of acute abdomen; the abdominal ultrasound was negative on day 0. Clostridium difficile colitis was verified and treated with perorally administered vancomycin. On day 4, the discomfort changed to pain; the ultrasound scan revealed a finding suggestive of appendicitis. Surgical exploration revealed perforated appendicitis, and appendectomy was performed. From a surgical point of view, the patient's follow-up was uneventful. The patient underwent a successful embryo transfer 6 months after the appendectomy. The patient gave birth to a healthy boy at the 35
th week of gestation., Conclusion: A high index of suspicion of an atypical course and symptomatology of acute abdomen should be maintained in immunosuppressed patients., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.)- Published
- 2019
- Full Text
- View/download PDF
26. Familial Adenomatous Polyposis and Desmoid Tumor Treated with Multivisceral Transplantation and Kidney Autotransplantation: Case Report and Literature Review.
- Author
-
Janousek L, Novotny R, Kudla M, Oliverius M, Wohl P, Minguet J, Martinek J, Hucl T, and Fronek J
- Abstract
Introduction: Desmoid tumours (DT) are commonly associated with Gardener's syndrome. Their surgical resection may be complicated by their close proximity to major vessels, multiple organ involvement, and frequent local recurrence. Multivisceral transplantation (MVTx) is an alternative treatment for patients with intestinal and liver failure. In patients with DT closely associated with renal structures but without end-stage kidney disease, concomitant excision of the patient's own kidney, ex vivo tumour resection with nephron-sparing surgery, or autotransplantation has been proposed., Case Presentation: A 36-year-old Caucasian female weighing 60 kg with Gardener's syndrome with a history of abdominal surgery was presented to our department with progressive abdominal distention associated with paroxysmal pain. With the use of CT, the patient was diagnosed with a mass arising from the mesenterial region. The patient had normal kidney function and nonalcoholic steatohepatitis. The patient was indicated for MVTx., Management and Outcome: After 16 months on the waiting list, the patient received a multivisceral graft from a deceased donor. Following the restoration of graft vascular flow, the patient's right kidney was removed and the DT dissected ex vivo before autotransplantation into the right pelvic fossa. The patient received immunosuppressive, antithrombotic, and antibiotic treatment. There was no acute rejection, though the patient experienced pulmonary infection, dysphagia, and oesophageal reflux with fungal infection. The patient had required temporary dialysis for acute renal failure for 75 days. One year after the surgery, nausea and violent vomiting caused delayed gastric emptying caused by spastic pylorus. Clinical improvement was achieved using gastric peroral endoscopic myotomy (G-POEM)., Conclusion: MVTx with kidney autotransplantation is a feasible treatment option in patients with familiar adenomatous polyposis complicated by an abdominal DT. Precise tumour dissection with nephron-sparing surgery was carried ex vivo. G-POEM was used to relieve MVTx-related gastroparesis. The patient had no disease reoccurrence after one-year follow-up., Competing Interests: The authors declares that they have no conflicts of interest., (Copyright © 2019 Libor Janousek et al.)
- Published
- 2019
- Full Text
- View/download PDF
27. The effect of cytokines produced by human adipose tissue on monocyte adhesion to the endothelium.
- Author
-
Cejkova S, Kubatova H, Thieme F, Janousek L, Fronek J, Poledne R, and Kralova Lesna I
- Subjects
- Adult, Atherosclerosis pathology, Cells, Cultured, Culture Media, Conditioned pharmacology, Endothelial Cells metabolism, Humans, Intercellular Adhesion Molecule-1 metabolism, Middle Aged, Vascular Cell Adhesion Molecule-1 metabolism, Cell Adhesion physiology, Cytokines metabolism, Endothelium, Vascular metabolism, Intra-Abdominal Fat metabolism, Monocytes metabolism
- Abstract
Visceral adipose tissue (VAT) may play a critical role in atherosclerotic cardiovascular disease. The goal of this study was to determine the effect of human VAT-released pro‑inflammatory cytokines on monocyte adhesion to the endothelium. The cytokine effects on monocyte adhesion to the endothelial cells (ECs) were tested using adipose tissue-conditioned media (ATCM) prepared by culturing human VAT. The cytokines concentrations in ATCM, the cytokines expression and adhesion molecules in stimulated ECs were measured. The concentrations of IL-1β,TNF-α,MCP-1,IL-10,and RANTES measured in ATCM correlated positively with monocyte adhesiveness to ECs. Additionally, ATCM increased the adhesion molecules (ICAM-1, VCAM-1) gene expression. Selective inhibitors highlighted the importance of IL-1β and TNF-α in the process by a significant decrease in monocyte adhesion compared to ATCM preconditioning without inhibitors. Human VAT significantly increased monocyte adhesion to ECs. It was significantly influenced by IL-1β, TNF-α, MCP-1, IL-10, and RANTES, with IL-1β and TNF‑α having the strongest impact.
- Published
- 2019
- Full Text
- View/download PDF
28. Large Hepatic Artery Pseudoaneurysm Resection After Orthotopic Liver Transplantation.
- Author
-
Novotny R, Janousek L, Lipar K, Chlupac J, and Fronek J
- Subjects
- Adult, Anastomosis, Surgical, Constriction, Pathologic complications, Female, Graft Survival, Humans, Stents adverse effects, Treatment Outcome, Aneurysm, False etiology, Hepatic Artery surgery, Liver Transplantation adverse effects
- Abstract
BACKGROUND Hepatic artery (HA) pseudoaneurysm (PSA) after liver transplantation (OLTx) is rare but often fatal complication requiring quick repair. Its prevalence in patients after OLTx is around 0.94%. CASE REPORT A 41-year-old female patient underwent a full-graft orthotopic liver transplantation (OLTx) for alcoholic liver cirrhosis in 2017. During regular postoperative Doppler ultrasonography (DU) check-ups, a large 3-cm pseudoaneurysm (PSA) was detected on the hepatic artery. The patient underwent a computed angiography (CTA) to verify the PSA anatomical localization and relationship with the transplanted liver graft. Selective celiac arteriography showed HA PSA and 90% stenosis of the hepatic artery after PSA. The stent graft placement was unsuccessful as the guiding wire was unable to pass through the post-PSA HA stenosis. The patient was scheduled for an open repair under general anesthesia. Through a right subcostal incision, the HA PSA was resected and the HA was mobilized and re-anastomosed using an end-to-end technique. Three months after the procedure, the patient has a good liver graft perfusion through the HA with no sign of PSA reoccurrence or stenosis. CONCLUSIONS Early detection of the HA PSA after OLTx is a life-threatening complication requiring prompt treatment. If endovascular treatment options fail, open surgical repair, despite its challenges, is the only possible treatment option.
- Published
- 2019
- Full Text
- View/download PDF
29. Deceased Donor Renal Transplantation Combined with Bilateral Nephrectomy in a Patient with Tuberous Sclerosis and Renal Failure.
- Author
-
Novotny R, Chlupac J, Marada T, Bloudickova-Rajnochova S, Vavrinova H, Janousek L, and Fronek J
- Abstract
Introduction: A 27-year-old female patient with known tuberous sclerosis complex (TSC), polycystic kidneys with multiple large bilateral angiomyolipomas, and failing renal functions with prehemodialysis values (urea: 19 mmol/L; creatinine: 317 μ mol/L; CKD-EPI 0,27) was admitted to our department for pre-renal transplant evaluation. The patient was placed on the transplant waiting list as the living donor did not pass pretransplant workup and was subsequently contraindicated. Patient was placed on the "cadaverous kidney transplant waiting list"., Method: Computed tomography angiography revealed symptomatic PSA in the right kidney angiomyolipoma (AML). The patient underwent urgent transarterial embolisation of the PSA's feeding vessel in the right kidney AML. Based on the "kidney transplant waiting list" order patient underwent a bilateral nephrectomy combined with transperitoneal renal allotransplantation of a cadaverous kidney graft through midline laparotomy, appendectomy, and cholecystectomy., Results: Postoperative period was complicated by delayed graft function caused by acute tubular necrosis requiring postoperative hemodialysis. The patient was discharged on the 17th postoperative day with a good renal graft function. Patient's follow-up is currently 23 months with good graft function (urea: 9 mmol/L; creatinine: 100 μ mol/L)., Conclusion: Renal transplantation combined with radical nephrectomy provides a definitive treatment for TSC renal manifestations.
- Published
- 2019
- Full Text
- View/download PDF
30. Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations.
- Author
-
Chmel R, Novackova M, Janousek L, Matecha J, Pastor Z, Maluskova J, Cekal M, Kristek J, Olausson M, and Fronek J
- Subjects
- Adolescent, Adult, Clinical Trials as Topic, Czech Republic, Female, Follow-Up Studies, Graft Survival, Humans, Middle Aged, Prognosis, Young Adult, Death, Infertility, Female surgery, Living Donors supply & distribution, Organ Transplantation methods, Tissue Donors supply & distribution, Tissue and Organ Harvesting methods, Uterus transplantation
- Abstract
Although uterus transplantation is still in the experimental stage, it has promising potential as a treatment for women with absolute uterine factor infertility based on the childbirths from living donor trials conducted in Sweden and the United States. We report the main characteristics and perioperative and postoperative courses of both recipients and donors following 4 deceased donor and 5 living donor uterus transplantations. Three main priorities differentiate this study from the previously reported uterus transplantations. First, clinical experience with the largest worldwide group of deceased donor uterine transplants is described. Second, in the majority of living donor uterine recipients, only 2 ovarian veins were used for venous blood outflow. All of these recipient procedures were surgically successful, and follow-up posttransplant ultrasound examinations revealed normal uterine blood supply and outflow. Third, in only one living and one deceased donor recipient, the transplanted uterus relied on only 2 uterine veins for venous outflow with a 50% surgical success rate. In all other recipients, 2 uterine and 2 ovarian veins were utilized. Although a successful pregnancy has not yet been achieved, the presented surgical and functional results of our trial are promising., (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2019
- Full Text
- View/download PDF
31. Spontaneous Isolated Common Iliac Artery Dissection Treated with Self-Expandable Stent in a 38-year-old Patient: A Case Report.
- Author
-
Novotny R, Chlupac J, Beran J, Janousek L, and Fronek J
- Abstract
Introduction: Isolated iliac artery dissection (ISIAD) without the involvement of the aorta is a rare medical condition., Report: A case of a 38-year-old man with sudden onset of rest pain and paraesthesia on the right lower limb (RLL) is presented. Upon admission, the RLL was pulseless, with mild paraesthesia in the foot. The patient underwent computed tomography angiography, which revealed isolated common iliac artery (CIA) dissection followed by endovascular treatment (stenting) of the CIA dissection, with an instant therapeutic effect. Hospital stay was uneventful. The patient was discharged on the third post-procedural day., Discussion: Endovascular treatment of ISIAD is a viable treatment modality, with low periprocedural complications, mortality, and morbidity. Owing to its mini-invasiveness, it is a viable treatment modality.
- Published
- 2018
- Full Text
- View/download PDF
32. Transabdominal two-cavity approach for radical nephrectomy combined with inferior vena cava thrombectomy for malignant thrombus caused by renal cell carcinoma: a case series.
- Author
-
Novotny R, Chlupac J, Marada T, Borovicka V, Vik V, Voska L, Janousek L, and Fronek J
- Subjects
- Aged, Carcinoma, Renal Cell diagnostic imaging, Echocardiography, Transesophageal, Female, Humans, Kidney Neoplasms diagnostic imaging, Middle Aged, Treatment Outcome, Venous Thrombosis diagnostic imaging, Venous Thrombosis etiology, Abdomen surgery, Carcinoma, Renal Cell complications, Kidney Neoplasms complications, Nephrectomy, Thrombectomy, Vena Cava, Inferior surgery, Venous Thrombosis surgery
- Abstract
Background: Advanced renal cell carcinoma in some cases causes malignant intravascular thrombus with the potential for growth into the inferior vena cava or even the right atrium. Renal cell carcinoma is accompanied by malignant intravascular thrombus in up to 10% of cases. We present an overview of three patients diagnosed as having renal cell carcinoma with malignant intravascular thrombus requiring radical nephrectomy combined with inferior vena cava thrombectomy., Case Presentation: Three patients diagnosed as having renal cell carcinoma were indicated for renal cell carcinoma combined with inferior vena cava thrombectomy between 2014 and 2017 at our department: a 69-year-old white Caucasian woman, a 74-year-old white Caucasian woman, and a 58-year-old white Caucasian woman. According to the Novick classification of inferior vena cava tumor thrombus, there was one infrahepatic (level II) and two supradiaphragmatic (level IV) malignant intravascular thrombi. The average age of these patients was 67 years (range 58-74 years). All patients underwent radical nephrectomy combined with inferior vena cava thrombectomy through transabdominal approach. In patients with level IV malignant intravascular thrombus, transesophageal echocardiogram was used to guide the placement of the inferior vena cava cross-clamp above the diaphragm. In one patient the pericardium was opened to place a cross-clamp above a tumor just below the right atrium. There were no postoperative mortalities to date with an average follow-up of 23 months (range 2-48 months). To date, no patient has demonstrated recurrent inferior vena cava malignant intravascular thrombus requiring secondary inferior vena cava thrombectomy or any other treatment. A comparison of estimated blood loss and transfusion rate was not significantly different in all three cases., Conclusion: Despite the technical complexity of the procedure, caval thrombectomy combined with radical nephrectomy currently represents the only radical treatment for renal cell carcinoma accompanied by malignant intravascular thrombus with good mid-term oncological outcomes.
- Published
- 2018
- Full Text
- View/download PDF
33. The Effects of Diuresis, Duration of Dialysis and Age on Lower Urinary Tract Function in Urologically Healthy Male Patients on the Waiting List for Kidney Transplant.
- Author
-
Zachoval R, Borovicka V, Marada T, Viklicky O, Fronek J, Krhut J, Janousek L, Slatinska J, and Nencka P
- Subjects
- Age Factors, Aged, Area Under Curve, Compliance, Humans, Kidney Transplantation, Male, Middle Aged, Muscle Contraction, Muscle, Smooth physiopathology, ROC Curve, Renal Insufficiency, Chronic therapy, Time Factors, Urination, Urine, Waiting Lists, Diuresis, Renal Dialysis, Renal Insufficiency, Chronic physiopathology, Urinary Bladder physiopathology, Urodynamics
- Abstract
Purpose: This work investigated the effects of diuresis, duration of dialysis and age on lower urinary tract function in urologically healthy males on the waiting list for kidney transplant., Materials and Methods: The study included all men who had kidney transplants at our centre between January 2009 and December 2014 who had normal urological findings prior to inclusion on the list. Diuresis, the duration of haemodialysis, age, and parameters of function of the lower urinary tract as determined by filling and voiding cystometry were evaluated., Results: The study included 127 men (median age, 59 years; median diuresis, 250 mL; median duration of dialysis, 469.5 days). We found that greater diuresis was accompanied by significantly higher FDV, FDV/Cmax, NDV,Cmax and compliance and by significantly lower Pdet.max, PdetQmax and BOOI. Longer duration of dialysis was accompanied by significantly lower FDV, NDV and Cmax, compliance and Qmax.p and with significantlyhigher Pdet.max, PdetQmax and BOOI. Older age was associated with significantly higher Pdet.max and with significantly lower compliance. Worsening of the basic parameters of the storage function of the lower urinary tract occurred when diuresis decreased to 500-750 mL, when the duration of dialysis was one year and when patients were older than 54 years., Conclusion: In healthy male patients on the waiting list for kidney transplant, there were connections between the occurrence of dysfunctions of the lower urinary tract and diuresis, duration of dialysis and age. Patients should be monitored for dysfunctions of the lower urinary tract before and after transplantation.
- Published
- 2018
- Full Text
- View/download PDF
34. Cardiovascular disease predictors and adipose tissue macrophage polarization: Is there a link?
- Author
-
Kralova Lesna I, Petras M, Cejkova S, Kralova A, Fronek J, Janousek L, Thieme F, Tyll T, and Poledne R
- Subjects
- Adult, Age Factors, Biomarkers blood, Body Mass Index, Case-Control Studies, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypercholesterolemia blood, Hypercholesterolemia drug therapy, Hypercholesterolemia pathology, Inflammation Mediators blood, Intra-Abdominal Fat drug effects, Intra-Abdominal Fat metabolism, Macrophages drug effects, Macrophages metabolism, Male, Middle Aged, Peripheral Arterial Disease blood, Peripheral Arterial Disease surgery, Phagocytosis, Phenotype, Prognosis, Risk Factors, Sex Factors, Subcutaneous Fat drug effects, Subcutaneous Fat metabolism, Intra-Abdominal Fat pathology, Macrophages pathology, Peripheral Arterial Disease pathology, Subcutaneous Fat pathology
- Abstract
Background The risk of cardiovascular disease is closely connected to adipose tissue inflammation. The links between cardiovascular risk predictors and pro and anti-inflammatory macrophages in human adipose tissue were analysed to gain an insight into the pathophysiology of cardiovascular disease. Design Subcutaneous and visceral adipose tissues were obtained from 79 subjects, 52 living kidney donors (during nephrectomy) and 27 patients with peripheral artery disease (during arterial tree reconstruction). Methods Macrophage subsets were isolated from adipose tissues and analysed by flow cytometry using CD14, CD16, CD36 and CD163 monoclonal antibodies. The mutually adjusted differences of phagocytic pro-inflammatory (CD14 + CD16 + CD36
high ), anti-inflammatory (CD14 + CD16-CD163+) and transitional subsets of macrophages were analysed in relation to cardiovascular predictors (sex, age, body mass index, smoking, hypercholesterolaemia, hypertension and statin treatment). Results Age, male sex and hypercholesterolaemia were closely positively associated with the phagocytic pro-inflammatory macrophage subset in visceral adipose tissues. Interestingly, the proportion of phagocytic pro-inflammatory macrophages was relevantly decreased by statin therapy. A strong positive association of body mass index to the phagocytic pro-inflammatory subset was found in subcutaneous adipose tissues only. A minor transitional subpopulation, CD14 + CD16 + CD36low CD163+, increased with age in both adipose tissues. This transitional subpopulation was also negatively associated with obesity and hypercholesterolaemia in visceral adipose tissues. Conclusion An effect of cardiovascular risk predictors on adipose tissue macrophage subpopulations was revealed. Interestingly, while age, male sex and hypercholesterolaemia were connected with the pro-inflammatory macrophage subpopulation in visceral adipose tissues, body mass index had a prominent effect in subcutaneous adipose tissues only. A decreasing effect of statins on these pro-inflammatory macrophages was documented.- Published
- 2018
- Full Text
- View/download PDF
35. Aorto-iliac endarterectomy: Old-fashioned or re-newed method?
- Author
-
Chlupac J, Marada T, Thieme F, Malý S, Novotný R, Pantoflicek T, Sutoris K, Vysohlid R, Lipár K, Janousek L, and Froněk J
- Subjects
- Aged, Femoral Artery surgery, Humans, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Vascular Patency, Arterial Occlusive Diseases surgery, Endarterectomy methods, Iliac Artery surgery
- Abstract
Introduction: Aorto-iliac occlusive disease is best treated with endovascular angioplasty/stenting or surgical bypass, depending on disease severity. Aorto-iliac endarterectomy was frequently used until the 1980s. However, it can still be performed in cases of previous failure or contraindication of standard methods. The aim was a retrospective evaluation of a single-center case series of aorto-iliac endarterectomy., Methods: Seven patients at mean age 60±8 years (5768 years) were treated by aorto-iliac endarterectomy between 2013 and 2018. Rutherford categories of leg ischemia were 2 (moderate claudication) 3x, 3 (severe claudication) 2x, 4 (rest pain) and 5 (toe gangrene). The reasons for endarterectomy approach were: late in-stent iliac occlusion in an oncology patient, failure or complication of previous endovascular treatment of short iliac stenosis 2×, high infection risk of prosthesis use in long iliac-femoral occlusion, and short iliac occlusions 3x. Two patients after previous organ transplant were on immunosuppression., Results: Technical success rate was 100%. There was no peri-operative (30 days) death or amputation. Mean follow-up was 17 months (1.1 month3.3 year). One patient required additional tibial bypass 1 month after endarterectomy to heal foot gangrene. One patient developed symptomatic re-stenosis which was treated with iliac stenting 8 months after procedure. All patients clinically improved and recovered from leg ischemia. Two patients died of tumor with preserved limb 1.1 month and 3.1 years after procedure, respectively. Five remaining patients are asymptomatic with patent revascularization to date., Conclusion: Aorto-iliac endarterectomy is a vital alternative technique for revascularization in selected patients when other methods seem inappropriate. Key words: endarterectomy - peripheral arterial disease - iliac artery - abdominal aorta.
- Published
- 2018
36. Human adipose tissue accumulation is associated with pro-inflammatory changes in subcutaneous rather than visceral adipose tissue.
- Author
-
Lesna IK, Cejkova S, Kralova A, Fronek J, Petras M, Sekerkova A, Thieme F, Janousek L, and Poledne R
- Subjects
- Adult, Female, Humans, Inflammation metabolism, Male, Middle Aged, Obesity metabolism, Phagocytes metabolism, Body Mass Index, Inflammation etiology, Intra-Abdominal Fat metabolism, Macrophages metabolism, Obesity complications, Subcutaneous Fat metabolism
- Abstract
The importance of the involvement of adipose tissue macrophage subpopulations in obesity-related disorders is well known from different animal models, but human data are scarcer. Subcutaneous (n=44) and visceral (n=52) adipose tissues of healthy living kidney donors were obtained during living donor nephrectomy. Stromal vascular fractions were isolated and analysed by flow cytometry using CD14, CD16, CD36 and CD163 antibodies. Total macrophage numbers in subcutaneous adipose tissue increased (P=0.02) with body mass index (BMI), with a similar increase seen in the proportion of phagocytic CD14+CD16+CD36
high macrophages (P<0.01). On the other hand, there was an inverse correlation between anti-inflammatory CD14+CD16-CD163+ macrophages (P<0.05) and BMI. These correlations disappeared after excluding obese subjects (BMI ⩾30 kg m-2 ) from the analysis. Interestingly, none of these subpopulations were significantly related to BMI in visceral adipose tissue. Obesity per se is associated with distinct, highly phagocytic macrophage accumulation in human subcutaneous adipose tissue.- Published
- 2017
- Full Text
- View/download PDF
37. Bile Duct Anastomosis Supplied With Biodegradable Stent in Liver Transplantation: The Initial Experience.
- Author
-
Janousek L, Maly S, Oliverius M, Kocik M, Kucera M, and Fronek J
- Subjects
- Adult, Aged, Anastomosis, Surgical instrumentation, Anastomosis, Surgical methods, Bile Ducts surgery, Biliary Tract Surgical Procedures methods, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Absorbable Implants, Biliary Tract Surgical Procedures instrumentation, Liver Transplantation methods, Stents
- Abstract
Background: The most common biliary complications after orthotopic liver transplantation are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dysfunction. These complications can occur in up to 10% to 30% of liver transplant recipients. Leaks occur early in the posttransplant period; the stricture formation typically graduates over time., Methods: Ten patients underwent transplantation in our preliminary study: 5 were randomized to the group with stent placement and 5 to the control group. We investigated the role of an absorbable biliary stent with the goal of proving patency of duct-to-duct biliary anastomosis. The stents are made of machine-knitted polydioxanone monofilaments., Results: Our initial results show that duct-to-duct biliary reconstruction using an absorbable internal stent had good patency in all 5 patients. There were no signs of biliary leakage accompanying the anastomoses in any of the cases, and there was no stone formation observed after liver transplantation. The biliary stent was completely absorbed, with no adverse effects., Conclusions: Based on our initial experience and data, we concluded that biodegradable stents can be successfully and safely used in clinical practice. Further large prospective randomized studies are needed to estimate the efficacy of the bioabsorbable stents., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
38. Deceased donor uterus retrieval - The first Czech experience.
- Author
-
Froněk J, Janousek L, and Chmel R
- Subjects
- Adult, Brain Death, Czech Republic, Female, Humans, Tissue and Organ Harvesting, Tissue Donors, Uterus transplantation
- Abstract
Introduction: Uterus transplantation is the youngest solid organ transplantation described in the literature. This procedure is the only treatment method for congenital or acquired Absolute Uterine Factor Infertility., Method: The method is not recognised as standard clinical care yet, there were only some 13 cases performed worldwide so far. There is only one clinical trial worldwide, which has proven both feasibility and also healthy child delivery., Results: Czech Republic Ministry of Health permitted the uterus transplant clinical trial in 2015. The first phase of the surgical part includes performance and description of the uterus retrieval from a deceased donor., Conclusions: The first uterus retrieval from a deceased donor as a part of multi-organ retrieval was performed in the Czech Republic on January 13th, 2016; the case is described in the paper., Key Words: uterus - transplantation - deceased - donor - retrieval.
- Published
- 2016
39. Characterisation and comparison of adipose tissue macrophages from human subcutaneous, visceral and perivascular adipose tissue.
- Author
-
Kralova Lesna I, Kralova A, Cejkova S, Fronek J, Petras M, Sekerkova A, Thieme F, Janousek L, and Poledne R
- Subjects
- Cell Separation, Female, Flow Cytometry, Humans, Male, Middle Aged, Phenotype, Tissue Donors, Intra-Abdominal Fat cytology, Macrophages cytology, Subcutaneous Fat cytology
- Abstract
Background and Aims: Macrophages play important roles in adipose tissue inflammation and its consequences. Unfortunately, a detailed description of the macrophage phenotypes in different human adipose tissues is not available., Subjects and Methods: Subcutaneous, visceral and perivascular adipose tissues were obtained from 52 living kidney donors during live donor nephrectomy. Stromal vascular fractions were isolated, and the macrophage phenotypes were analyzed by flow cytometry using surface markers (CD14, CD16, CD36, and CD163)., Results: In addition to CD16 positivity, pro-inflammatory macrophages also display high scavenger receptor CD36 expression. The great majority of CD16 negative macrophages express the anti-inflammatory CD163 marker. The presence of pro-inflammatory macrophages was almost twice as high in visceral (p < 0.0001) and perivascular (p < 0.0001) adipose tissues than in subcutaneous tissue. This difference was substantially more pronounced in the postmenopausal women subgroup, consequentlly, the total difference was driven by this subgroup., Conclusion: We obtained detailed information about M1 and M2 macrophage phenotypes in human adipose tissue. The visceral and perivascular adipose tissues had substantially higher pro-inflammatory characteristics than the subcutaneous tissue. The higher proportion of pro-inflammatory macrophages in the visceral adipose tissue of postmenopausal women might be related to an increased cardiovascular risk.
- Published
- 2016
- Full Text
- View/download PDF
40. The effect of ectopic fat on graft function after living kidney transplantation.
- Author
-
Thieme F, Janousek L, Fronek J, Kralova A, Cejkova S, Kralova Lesna I, and Poledne R
- Subjects
- Adult, Dyslipidemias epidemiology, Dyslipidemias metabolism, Female, Glomerular Filtration Rate physiology, Humans, Hypertension epidemiology, Hypertension metabolism, Kidney Transplantation adverse effects, Male, Middle Aged, Retrospective Studies, Risk Factors, Treatment Outcome, Adipose Tissue metabolism, Body Mass Index, Graft Survival physiology, Kidney Transplantation trends, Living Donors
- Abstract
Renal transplantation is associated with a large number of risk factors that can have an influence on early renal graft function (ERGF). One of these factors could be the increasing number of obese kidney donors. The mechanisms of reduced ERGF in obese kidney donors are still poorly understood. To that end, we compared ERGF in recipients with body mass index (BMI), perivascular fat and plasma inflammation markers of live kidney donors. We hypothesized that the BMI of donors would negatively correlate with an average increase of glomerular filtration rate (GFR) and that it would also be associated with increased perivascular and plasma inflammation markers in the first seven days after transplantation. Between January 2013 and December 2014, some 58 living kidney transplantation pairs were included in the study. Donor and recipient demographic data, preoperative BMI, blood C-reactive protein (CRP) and adiponectin levels, perivascular adipose tissue (PAT) samples and recipient blood creatinine levels were analyzed. The median CRP of donors was 0.68 mg/l (max: 8.66 mg/l, min: 0.33 mg/l), the median of M1 macrophages (CD14+CD16+) in one gram of PAT was 5940 (max: 41 100, min: 248) and the median of adiponectin was 411 930 pg/ml (max: 14 217 000, min: 167 300) in plasma. We did not find any association between early renal graft function and the percentage of M1 macrophages in donor perirenal adipose tissue (p=0.83, r=0.03, n=58), adiponectin (p=0.65, r=0.06, n=58) or CRP (p=0.16, r=0.2, n=58) in plasma. The obesity level of donors, expressed as BMI, did not correlate with early renal graft function in the first seven days after transplantation. The associations between ERGF and plasma and perivascular fat inflammation markers were not significant. We confirmed a negative correlation between the BMI of recipients and an average increase of GFR in the first seven days after transplantation (p<0.02, r=-0.325, N=58). We confirmed a negative correlation of adiponectin plasma concentration to the BMI of donors.
- Published
- 2015
- Full Text
- View/download PDF
41. Tubular atrophy and low netrin-1 gene expression are associated with delayed kidney allograft function.
- Author
-
Wohlfahrtova M, Brabcova I, Zelezny F, Balaz P, Janousek L, Honsova E, Lodererova A, Wohlfahrt P, and Viklicky O
- Subjects
- Atrophy, Biopsy, Delayed Graft Function metabolism, Delayed Graft Function pathology, Gene Expression Regulation, Humans, Immunohistochemistry, Logistic Models, Nerve Growth Factors analysis, Netrin-1, Principal Component Analysis, Prospective Studies, Reperfusion Injury complications, Tumor Suppressor Proteins analysis, Delayed Graft Function etiology, Kidney Transplantation adverse effects, Kidney Tubules pathology, Nerve Growth Factors genetics, Tumor Suppressor Proteins genetics
- Abstract
Background: Delayed graft function (DGF) caused by ischemia/reperfusion injury (I/RI) negatively influences the outcome of kidney transplantation. This prospective single-center study characterized the intrarenal transcriptome during I/RI as a means of identifying genes associated with DGF development., Methods: Characterization of the intrarenal transcription profile associated with I/RI was carried out on three sequential graft biopsies from respective allografts before and during transplantation. The intragraft expression of 92 candidate genes was measured using quantitative real-time reverse transcriptase polymerase chain reaction (2) in delayed (n=9) and primary function allografts (n=26)., Results: Cold storage was not associated with significant changes to the expression profile of the target gene transcripts; however, up-regulation of 16 genes associated with enhanced activation of innate and adaptive immune responses and apoptosis was observed after reperfusion. Multivariate logistic regression analysis revealed that higher tubular atrophy scores (ct) together with a lower expression of Netrin-1 might predict DGF development (training area under the receiver operating curve=0.89, cross-validated area under the receiver operating curve=0.81)., Conclusions: Poor baseline tubular cell quality (defined by a higher rate of tubular atrophy) combined with the reduced potential of apoptotic survival factors represented by decreased Netrin-1 gene expression were associated with delayed kidney graft function.
- Published
- 2014
- Full Text
- View/download PDF
42. Kidney transplant early venous complications managed by reperfusion and re-transplantation - salvage procedure.
- Author
-
Janousek L, Kudla M, Slatinska J, Viklicky O, and Fronek J
- Subjects
- Adult, Cohort Studies, Early Diagnosis, Female, Follow-Up Studies, Graft Occlusion, Vascular diagnosis, Graft Survival, Humans, Kidney Transplantation methods, Male, Middle Aged, Reoperation, Tissue Donors, Treatment Outcome, Venous Thrombosis diagnosis, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular surgery, Kidney Transplantation adverse effects, Renal Veins surgery, Salvage Therapy methods, Venous Thrombosis etiology, Venous Thrombosis surgery
- Abstract
We report five cases of early venous complications, all successfully rescued by graft removal, re-perfusion and re-transplantation, these kidneys would have been lost otherwise. All kidneys were from deceased donors, mean donor age was 39 years (range 29-55), with serum creatitine levels on harvesting being 81 μmol/l (65-108), glomerular filtration of 1.46 ml/s (0.82-1.83). Reasons for venous complications were following: Two cases of renal vein stenosis, another two with renal vein laceration, one renal vein thrombosis for unknown reason. All the five kidney grafts have been rescued successfully. One year's results in this group comes as mean serum creatinine level of 127 μmol/l. The described approach gives a chance to the patients with early vein thrombosis and offers the kidney graft salvage (Ref. 4).
- Published
- 2014
43. Dual kidney transplant: a single-center experience and review of the literature.
- Author
-
Balaz P, Rokosny S, Wohlfahrt P, Wohlfahrtova M, Adamec M, Janousek L, Fronek J, Viklicky O, and Pokorna E
- Subjects
- Acute Disease, Aged, Czech Republic, Delayed Graft Function etiology, Delayed Graft Function mortality, Female, Graft Rejection etiology, Graft Rejection mortality, Graft Survival, Humans, Kaplan-Meier Estimate, Kidney Transplantation adverse effects, Kidney Transplantation mortality, Male, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Donor Selection, Kidney Transplantation methods, Tissue Donors supply & distribution
- Abstract
Objectives: Adult dual kidney transplant is a strategy to overcome the imbalance between limited nephron mass supplied from an older donor and a recipient with a metabolic request., Materials and Methods: In our report, we review the literature and present our single-center experience. From June 2007 until July 2012, nine hundred twenty-eight single and seventeen dual kidney transplants from deceased donors were performed., Results: The average donor was 71.5 ± 3.6 years of age with an average serum creatinine, creatinine clearance, and an average number of sclerotic glomeruli, 106.1 ± 44.2 μmol/L, 0.97 ± 0.37 mL/s, and 22.4 ± 14.2. Immediate graft function and acute rejection episodes were observed in 75% and 6% of patients. The overall patient survival rates at 1 and 2 years after transplant were 93%. The overall graft survival rates at 1 and 2 years were 88%., Conclusions: Previous studies and our single-center experience suggest that the dual transplant procedure may help improve results of kidney transplants from expanded criteria donors and extend the donor pool by using kidneys that would be discarded otherwise.
- Published
- 2013
- Full Text
- View/download PDF
44. Urgent liver transplantation for chemotherapy-induced HBV reactivation: a suitable option in patients recently treated for malignant lymphoma.
- Author
-
Sperl J, Frankova S, Kieslichova E, Oliverius M, Janousek L, Honsova E, Trunecka P, and Spicak J
- Subjects
- Adult, DNA, Viral analysis, Female, Hepatitis B virus genetics, Hepatitis B virus physiology, Humans, Male, Middle Aged, Retrospective Studies, Antineoplastic Agents adverse effects, Hepatitis B virus drug effects, Liver Transplantation, Lymphoma drug therapy, Virus Activation
- Abstract
Background: Hepatitis B (HBV) reactivation induced by chemotherapy is a problem currently encountered in the management of malignancies. HBV reactivation occurs particularly in patients who were not checked for HBV status, and therefore have not undergone antiviral prophylaxis. HBV reactivation may ultimately lead to fulminant liver failure (FLF). Liver transplantation (OLT), the only remaining effective treatment option, is generally denied for subjects with a recent history of malignancy., Case Reports: We described retrospectively three cases of FLF caused by HBV reactivation in two men and one woman undergoing rituximab-containing chemotherapy for malignant lymphomas: follicular, diffuse large B-cell and lymphoplasmacytic types. The two men reactivated after eight cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and the one woman after 13 cycles of rituximab monotherapy; their hematologic disease was in remission. All three patients were hepatitis B surface antigen (HBsAg)-positive with high HBV DNA levels. Neither man had been screened for HBV before chemotherapy; the woman had been treated with lamivudine (LAM) experiencing an HBV flare-up due to emergence of LAM resistance. All patients fulfilled King's College criteria for urgent OLT upon admission to the transplant center and underwent an urgent OLT. Their hemato-oncologic prognosis was considered to be favorable. All three patients are alive (54, 46, and 37 months post-transplantation), tumor-free and HBsAg negative on a standard HBV prophylaxis regimen: hepatitis B immunoglobulin and LAM + adefovir or tenofovir., Conclusions: Before chemotherapy appropriate prophylaxis for HBV reactivation should always be administered to at-risk patients. However, if reactivation with FLF occurs, OLT should not be generally denied. The prognosis of the hematologic malignancy should be assessed; OLT should be considered for patients in remission with a favorable long-term prognosis, for our data suggest acceptable survival., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
45. Early and late outcomes of hybrid endovascular and open repair procedures in patients with peripheral arterial disease.
- Author
-
Balaz P, Rokosny S, Wohlfahrt P, Adamec M, Janousek L, and Björck M
- Subjects
- Adult, Aged, Aged, 80 and over, Amputation, Surgical, Analysis of Variance, Chi-Square Distribution, Combined Modality Therapy, Czech Republic, Disease-Free Survival, Female, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Graft Occlusion, Vascular therapy, Humans, Kaplan-Meier Estimate, Limb Salvage, Male, Middle Aged, Peripheral Arterial Disease mortality, Peripheral Arterial Disease physiopathology, Peripheral Arterial Disease surgery, Reoperation, Retrospective Studies, Stents, Time Factors, Treatment Outcome, Vascular Patency, Angioplasty adverse effects, Angioplasty instrumentation, Angioplasty mortality, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Peripheral Arterial Disease therapy
- Abstract
Background: Hybrid endovascular and open reconstructions are used increasingly often for multilevel revascularization for lower limb ischaemia. The aim was to evaluate outcomes after such procedures in a single-center non-randomized retrospective study., Patients and Methods: Consecutive patients with multilevel arterial disease who underwent single session hybrid procedures were analyzed depending on the type of ischaemia and the type of revascularization., Results: 164 patients were included with a median follow up time of 14 months (range: 0 - 70). Indication was claudication (group 1, 47 %), critical limb ischaemia (group 2, 33 %) and acute limb ischaemia (group 3, 20 %). Technical success rate was 99.3 %, perioperative mortality 2 %. Primary, assisted-primary and secondary patency rates at one year were 60 %, 61 % and 64 %, respectively. Primary, primary assisted and secondary patency were lower in group 2 and 3 compared to group 1 (all p < 0.05). Results were better when endovascular repairs were performed above compared to below the open repair site (all p < 0.05). Limb salvage at 1 year in groups 1 - 3 were 98 %, 92 % and 90 %, respectively. The risk of major amputation was highest in group 3 compared to group 1 (p = 0.001) or group 2 (p < 0.04)., Conclusions: The results depend on the type of ischaemia and the localization of endovascular procedures.
- Published
- 2013
- Full Text
- View/download PDF
46. Comparison of gene expression of epicardial and visceral adipocytes with regard to the differentiation stage.
- Author
-
Zdychova J, Kralova Lesna I, Maluskova J, Janousek L, Cahova M, and Kazdova L
- Subjects
- Adipocytes cytology, Adipocytes physiology, Adult, Cells, Cultured, Chemokine CCL2 genetics, Chemokine CCL5 genetics, Gene Expression physiology, Humans, Interleukin-18 genetics, Interleukin-6 genetics, Interleukin-8 genetics, Pilot Projects, Cell Differentiation physiology, Cytokines genetics, Intra-Abdominal Fat cytology, Intra-Abdominal Fat physiology, Pericardium cytology, Pericardium physiology
- Abstract
Background: Our study focused on the ability of epicardial adipocytes to produce bioactive substances and compare the extent of this production with the production of adipokines in visceral adipocytes, which are well known endocrine cells capable of contributing to the development of atherosclerosis., Material and Methods: The gene expression of human cytokines (IL-6, IL-8, IL-18, RANTES and MCP-1) and adipokines (leptin and adiponectin) was measured in primary cell lines of epicardial and visceral adipocytes, both in undifferentiated and mature statuses, after a 21-day-long differentiation protocol. Each condition was assayed in triplicate in two independent primary cell lines obtained from two different donors., Results: The epicardial preadipocytes showed an increased expression of IL-8 (3.25-fold, p<0.05) compared with visceral preadipocytes. The expression of the atheroprotective adiponectin in epicardial preadipocytes was minimal compared with the expression in visceral preadipocytes (p<0.0001). Moreover, the expression of the genes of interest was dependent on the differentiation degree and cell origin. We observed an altered expression of the proinflammatory genes IL-8 (0.016-fold, p<0.01) and MCP-1 (0.19-fold, p<0.05) in differentiated epicardial adipocytes compared with undifferentiated adipocytes. The epicardial adipocytes showed an increased expression of IL-6 (8.13-fold, p<0.05) compared with the visceral adipocytes., Conclusion: Our results suggest that epicardial adipocytes substantially differ from visceral adipocytes and might locally contribute to the pathogenesis of coronary atherosclerosis.
- Published
- 2012
47. [Liver transplantation in patients with portal vein thrombosis].
- Author
-
Janousek L, Adamec M, Oliverius M, Trunecka P, and Kucera M
- Subjects
- Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Venous Thrombosis diagnosis, Venous Thrombosis etiology, Young Adult, Liver Transplantation adverse effects, Portal Vein, Venous Thrombosis surgery
- Abstract
Aim: The aim of the study was to perform a retrospective assessment in a group of patients with portal vein thromboses who underwent consecutive liver transplantation., Material and Methods: PVT was preoperatively diagnosed with ultrasound and CT portography. The follow up period was 1 to 6 years. Postoperative immunosuppressive medication was administered in combination with cyclosporin A, prednison and imuran upon initiation of the transplantation programme (8 patients). During the follow up period, the treatment protocol was replaced with FK 506, Cell Cept and prednisone. Liver biopsy was indicated when rejection was suspected., Results: During 1996-2009, the team of authors performed a total of 740 liver transplantations in 303 female and 437 male subjects. The procedures included 703 primary procedures, 33 retransplantations and four second retransplantations. Out of the total, 57 recipients (7.7%) had portal vein obliteration. These subjects included 42 male and 15 females, their mean age was 52 (9-67) years. 62 liver transplantations were performed in these 57 patients. The following complications were recorded in the patient group: graft dysfunction in 10.5%, revisions for bleeding in 28%, hepatic artery thrombosis in 10.5%, portal vein rethrombosis in 1.8%, biliary complications in 17.5%, acute rejections in 19.3%. Perioperative mortality rate was 15.8%.The mean blood derivates requirement was 17.1 (0-425) erythrocyte transfusion units, 27.1 (0-132) frozen plasma transfusion units and 2.6 (0-20) thrombocyte transfusion units., Conclusion: The results of out retrospective study indicate that portal thrombosis is not a contraindication for liver transplantation. Current surgical techniques make liver transplantations in patients with complete splanchnic venous thrombosis possible.
- Published
- 2011
48. [Immunosuppression following venous allografts transplantations--the authors' experience].
- Author
-
Adamec M, Matia I, and Janousek L
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Transplantation, Homologous, Vascular Surgical Procedures, Immunosuppressive Agents therapeutic use, Veins transplantation
- Abstract
Aim: Venous and arterial graft usage in vascular reconstructions was re-discovered in connection with organ transplantation development. Allografts are employed in many clinics, however, uniform opinion on the use of immunosuppression after the procedure of venous graft transfer from a cadaveric donor, is still lacking., Material and Methods: The authors present their own group of patients who underwent vascular reconstructions, and in whom allogenic vein was used. The majority of indications for bypass procedures resulted from critical limb ischemia. Immunosuppressive medication was administered during the vascular procedure and, over the past several years, it purely consisted of tacrolimus monotherapy., Results: In the group of 101 patients, no serious complications due to adverse effects of immunosuppression therapy were recorded.
- Published
- 2011
49. [Early biliary complications following liver transplantation].
- Author
-
Kucera M, Adamec M, Oliverius M, Janousek L, Kocík M, Spicák J, Stirand P, Drastich P, Peregrin J, and Trunecka P
- Subjects
- Anastomotic Leak diagnosis, Anastomotic Leak etiology, Anastomotic Leak surgery, Biliary Tract Diseases diagnosis, Biliary Tract Diseases surgery, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis diagnosis, Cholestasis etiology, Cholestasis surgery, Humans, Biliary Tract Diseases etiology, Liver Transplantation adverse effects
- Abstract
Introduction: Biliary complications (BC) after liver transplantation (LTx) are serious problems with an incidence rate of 6-35%. There are two types of BC, early and late. Early BC is observed for 30 days post LTx or during the entire period of the patient's first hospital stay after LTx. The main causes of early BC are ischemia of the biliary tree (the bile duct of the transplanted liver is supplied only from the right hepatic artery descendingly; the supply from the gastroduodenal artery is lacking) as well as implementation of the biliary anastomosis surgical technique. Treatment of BC is administered by a surgeon, a gastroenterologist and a radiologist., Aim: To evaluate early biliary complications after LTx, Patients and Methods: We reviewed patients with early BC after LTx from 4/2004 - 12/2009. We defined early BC as a complication that is present during the first 30 days post LTx or during the entire period of the patient's first hospital stay after LTx., Results: We performed 384 LTx during the above-mentioned period. We carried out reconstruction of the biliary tree in the form of a choledochocholedochostomy (CDD) in 312 cases and in the form of a choledochojejunostomy (CDJ) in 72 cases. Sixty-eight patients had early BC (17.7%), 25 patients experienced biliary leak (6.5%), 40 patients had anastomotic stenosis (10.4%) and 3 patients (0.8%) experienced both complications (biliary leak and stenosis). Most complications were eliminated by ERCP with a papilosfincterotomy, a balloon dilatation of stenosis, and a biliary stent implant with repeated stent replacements (45 cases in total- all patients with biliary stenosis). Twenty-two patients were reoperated on (16x CDJ, 3x re-CDD, 2x suture of aberrant bile duct, 1x suture common bile duct) and 1 patient was treated by percutaneous transhepatic bilary drainage (PTD). The mortality rate was zero., Conclusion: BC after LTx continue to pose a serious surgical problem. The treatment of choice when dealing with BC is ERCP, which has more than a 70% success rate. If ERCP or PTD are not successful, or when biliary peritonitis is present, we perform a reanastomosis of the bile duct. The combined effort of the surgeon, gastroenterologist and radiologist is the most important factor for successful treatment. The incidence of BC after LTx at IKEM is similar to that of treatment centers all over the world.
- Published
- 2011
50. [Eversion carotid endarterectomy: evaluation of results after changing the operation technique].
- Author
-
Janousek L, Marada T, Chlupác J, Lipár K, Baláz P, Rokosný S, Matia I, and Adamec M
- Subjects
- Aged, Aged, 80 and over, Carotid Stenosis complications, Endarterectomy, Carotid adverse effects, Female, Humans, Male, Middle Aged, Recurrence, Stroke, Treatment Outcome, Carotid Artery, Internal, Carotid Stenosis surgery, Endarterectomy, Carotid methods
- Abstract
Background: Stroke is the third most common cause of mortality, and carotid artery stenosis causes up to 30% of all ischemic strokes. Eversion CEA (ECEA) has been proposed as an acceptable alternative to the standard bifurcation endarterectomy in many patients. This study was designed to analyze the long-term durability of ECEA in symptomatic and asymptomatic patients. Data were retrospectively reviewed to determine the incidence of major adverse cardiovascular events (MACEs) within 30 days of surgery, late survival, and the incidence of restenosis., Methods and Results: From January 1999 to June 2010, 344 ECEAs were performed on 324 patients (34% female, 38% symptomatic). The mean follow-up period was 30 months., Conclusions: MACEs occurred in 28 patients (8.6%). The overall incidence of stroke or death after ECEA was 1.7% and 0.9% at discharge. The overall incidence of stoke or death after CEA was 4.3% and 21% (14 strokes, 69 deaths, 8 of which were stroke-related). The overall occurrence of any restenosis (> 50%) after CEA was 4.3% (14 of 324 procedures).
- Published
- 2011
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.