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Крымский полуостров - регион с разнообразными почвенными и климатическими условиями, является родиной более 70 сортов винограда. Сортимент винограда Крыма формировался на протяжении длительного времени в определённых условиях и обладает рядом ценных свойств и признаков. В статье приводится описание основных ампелографических и хозяйственно-биологических характеристик перспективного местного крымского столово-технического сорта среднепозднего периода созревания Солнечная Долина 58. Сорт пригоден для культивирования в юго-восточной прибрежной зоне Крыма при схеме посадки кустов 1,5 х 3,0 м и нагрузке 60 глазков на куст при обрезке 6-8 глазков. Хорошо растет и плодоносит на щебенистых почвах. Перспективен для приготовления красных столовых и десертных вин, и для потребления в свежем виде на месте. Сорт встречается только в коллекциях. The Crimean Peninsula as a region with a diversity of soil and climatic conditions is a home to more than 70 grape varieties. The assortment of grapes has been formed over a long period of time under certain conditions and has a number of valuable properties and traits. The article describes main ampelographic and economic-biological characteristics of the promising local Crimean table and wine grape variety ‘Solnechnaya Dolina 58’. The variety is suitable for cultivation in the south-eastern coastal zone of Crimea with bushes planting scheme of 1.5 x 3.0 m and a load of 60 eyes per bush when pruning 6-8 eyes. It grows well and fructifies on rank soils. It has good prospects for making red table and dessert wines, as well as for fresh consumption. The variety is met in collections only.

The Zádielska dolina (“Zadiel Gorge“) belongs to the most beautiful and from a natural science perspective to the most interesting landscape formations of the Slovak Karst. The area represents the National Nature Reserve in the National Park and is part the European Network of Protected Areas NATURA 2000. The site is characterized by climbing activity. This article provides suggestions of attractiveness in the field of climbing that respect the development of tourism in accordance with nature and landscape conservation. The basis for the proposals were theoretical knowledge, thorough analysis of the area and own experience with the issue. Recommendations from other climbing places and identification of problems between climbing and nature, have been key for us in making appropriate proposals. The increasing interest in adventure tourism, including climbing, means a global trend in tourism and therefore it is necessary to pay close attention to this issue.

In the paper – taking into account general understanding of poetry (poetry is something that is beautiful, sublime, unusual) – the textual structures of the novella that perform a poetic function have been analyzed; besides, the factors that determine the formation of the identity of the protagonist have been spotlighted. The poetic expression of the text, which introduces the developing of the plot into the natural and historical background, has been highlighted. From the poetics point of view, various portraits of heroes have been analyzed: external, psychological, and metaphysical; descriptions of the appearance and behavior of animals, birds, reptiles have been provided. What is more, in the aspect of poetic semantics and connotations, descriptions of landscapes, interiors have been analyzed; narrations about various processes of the ordinary and routine life and objects around the protagonist have been noticed. Poeticism is also represented in such textual structures as reasoning, especially concerning the fundamental issues of life and death. Taking into account the author’s strategy of reproducing the factors of identity creation, the protagonist explores his nature (and the human nature in general) through binary oppositions. Parents, environment, ancestors, history, motherland, and the home place, where he was born and where he grew up have influenced the formation of protagonist’s identity. This last telluric identity factor mostly shapes the peculiarity of Tomas’s worldview, as well as his Creator. Being a story about Lithuania at the beginning of the twentieth century, «The Issa Valley» is the story about true Lithuanian beliefs, customs, myths that existed that time; such senses make the text written in prose, poetic in its essence. Characteristics of the protagonist’s identity have been outlined: he is a person endowed with a talent of poetic vision of the world; he has religion feelings by the way, he also «tasted Manichaean poison»; patriotism rooted in nobility and in his small country – Lithuania. This is a being who becomes an organic part of the mental paradigm an animal – a human being – God.

The determination of solar irradiation is crucial when planning the installation of solar systems. There are different GIS models for determining solar irradiation, which differ from each other in terms of input data, hardware requirements, performance, reliability and suitability, depending on the specificity of the study area and the nature of the study. Because of their diversity, urban areas pose a greater challenge for the estimation of the potential of the received solar energy. In the article we offered a methodology for determining the irradiation of urban area roofs using the GRASS GIS model r.sun, which makes the computation with high resolution spatial, atmospheric and meteorological data. The used input data is freely available for the entire territory of Slovenia. The proposed methodological approach was tested in the area of the town quarter Rožna dolina with the northern part of Vič. The area is very diverse according to the typology of the built objects, the land cover and altitude differences.

On the eve of the second wave of feminism and the years for which it would often be said that they changed the world, a modestly successful actress from Philadelphia mesmerized the public with her dark story of sex, glamour and the world of the rich and famous. Readers were presented with another cult classic – Valley of the Dolls by Jacqueline Susann. The public was delighted, the critics in shock, and what remains of that turbulent 1966 is the unfading popularity of this controversial story. Some ascribe this popularity to the author’s ingenuity, others celebrate her as a herald of feminism, while most resent the fact that she used kitsch to gain great popularity and make money. This paper will deal with the possible reasons behind the unwavering popularity of this novel almost half a century after its publication, examining at the same time whether there is truth in the claims that through her work Jacqueline Susann contributed to the advent of feminism.

This article aims to explain the characteristics and development paths of North Brabant, during the transition from an economy based on industries to knowledge-based economy, using the highest industry technology and design. Attempts to identify the key moments of the transformation of the socio-economic development of the region and the consequences of its impact on changes in the economy. Reference is made to the historical foundations of economic success and the consequences introduced development strategy. Analyzed characteristics of this region and innovation indicators.

Background: Acromegaly is a disorder associated with hypersecretion of growth hormone, most usually caused by a pituitary adenoma. Dysmotility of the gastrointestinal tract has been reported in acromegalic patients. Achalasia is a disorder characterized by aperistalsis of the oesophagus with incomplete lower oesophageal sphincter relaxation and whose aetiology remains unknown. Mutations in some genes have previously been associated with the development of acromegaly or achalasia. The study aims were to analyse mutations in selected genes in a woman having both of these diseases, to identify their aetiological factors, and to suggest explanations for the co-incidence of acromegaly and achalasia. Methods and Results: A female patient with acromegaly, achalasia, and a multinodular thyroid gland with hyperplastic colloid nodules underwent successful treatment of achalasia via laparoscopic Heller myotomy, a thyroidectomy was performed, and the pituitary macroadenoma was surgically excised via transnasal endoscopic extirpation. Germline DNA from the leukocytes was analysed by sequencing methods for a panel of genes. No pathogenic mutation in AAAS, AIP, MEN1, CDKN1B, PRKAR1A, SDHB, GPR101, and GNAS genes was found in germline DNA. The somatic mutation c.601C>T/p.R201C in the GNAS gene was identified in DNA extracted from a tissue sample of the pituitary macroadenoma. Conclusions: We here describe the first case report to our knowledge of a patient with both acromegaly and achalasia. Association of acromegaly and soft muscle tissue hypertrophy may contribute to achalasia's development. If one of these diagnoses is determined, the other also should be considered along with increased risk of oesophageal and colorectal malignancy.

SARS-CoV-2 is an etiological factor in several diseases that the WHO designated covid-19. Covid-19 infection may affect the digestive tract, including the pancreas. The main/most common symptoms of covid-19 include fever (71.6%), cough (68.9%) subjective feeling of shortness of breath (71.2%). The gastrointestinal symptoms include abdominal pain, nausea and vomiting and/or diarrhea. The relationship of covid-19 and pancreas affection is not clearly described. A common finding is hyperlipasemia, eventually hyperamylasemia. Both conditions are usually associated with either no or minimal histomorphological changes, i.e. changes referred to as edematous glandular infiltration. Rarely, a necrotic form was reported. Nevertheless, the mortality of patients with acute pancreatitis who were covid-19 positive was higher than in covid-19 negative individuals. The available data indicate there is a link between covid-19 infection and the pancreas presenting as an acute disorder of the gland. SARS-CoV-2 impairment of both exocrine and endocrine function of the pancreas is multifactorial. It is debatable whether the involvement of the gland is directly related to the presence of the virus or whether it is an epiphenomenon. Angiotensin-converting enzyme 2 (ACE-2) receptors, inflammatory changes (especially in pancreatic beta cells), together with high IL-18 levels, virus-induced lipotoxicity and immunological dysregulation play an important role in the induction of pancreatic damage. During the covid-19 pandemic, pancreatopathies represent a very lively topic and are being studied intensively. Keywords SARS-CoV-2, COVID-19, chronic pancreatitis, pancreas, endoscopy

Helicobacter pylori (H. pylori) is an infectious agent influencing as much as 50% of the world’s population. It is the causative agent for several diseases, most especially gastric and duodenal peptic ulcer, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the stomach. A number of other, extragastric manifestations also are associated with H. pylori infection. These include neurological disorders, such as Alzheimer’s disease, demyelinating multiple sclerosis and Parkinson’s disease. There is also evidence for a relationship between H. pylori infection and such dermatological diseases as psoriasis and rosacea as well as a connection with infection and open-angle glaucoma. Generally little is known about the relationship between H. pylori infection and diseases of the pancreas. Most evidence about H. pylori and its potential role in the development of pancreatic diseases concerns pancreatic adenocarcinoma and autoimmune forms of chronic pancreatitis. There is data (albeit not fully consistent) indicating modestly increased pancreatic cancer risk in H. pylori-positive patients. The pathogenetic mechanism of this increase is not yet fully elucidated, but several theories have been proposed. Reduction of antral D-cells in H. pylori-positive patients causes a suppression of somatostatin secretion that, in turn, stimulates increased secretin secretion. That stimulates pancreatic growth and thus increases the risk of carcinogenesis. Alternatively, H. pylori, as a part of microbiome dysbiosis and the so-called oncobiome, is proven to be associated with pancreatic adenocarcinoma development via the promotion of cellular proliferation. The role of H. pylori in the inflammation characteristic of autoimmune pancreatitis seems to be explained by a mechanism of molecular mimicry among several proteins (mostly enzymes) of H. pylori and pancreatic tissue. Patients with autoimmune pancreatitis often show positivity for antibodies against H. pylori proteins. H. pylori, as a part of microbiome dysbiosis, also is viewed as a potential trigger of autoimmune inflammation of the pancreas. It is precisely these relationships (and associated equivocal conclusions) that constitute a center of attention among pancreatologists, immunologists and pathologists. In order to obtain clear and valid results, more studies on sufficiently large cohorts of patients are needed. The topic is itself sufficiently significant to draw the interest of clinicians and inspire further systematic research. Next-generation sequencing could play an important role in investigating the microbiome as a potential diagnostic and prognostic biomarker for pancreatic cancer.

Introduction: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy. Aim: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women. Materials and methods: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method. Results: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32–8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy. Conclusions: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women.

Crohn’s disease and ulcerative colitis are both chronic inflammatory bowel diseases (IBD). This article summarizes current best practice in treating pregnant patients with IBD, ranging from conservative therapy to endoscopy and imaging methods, including a description of surgical therapy indications. Female patients with IBD should ideally plan their pregnancies for when their disease is in remission. Patients in remission may also have complications during pregnancy, however the risk of complications is lower than in patients with active disease. Any chronic medications they were on before becoming pregnant (with the exception of teratogenic methotrexate) should remain unchanged. According to the current literature, pregnancy does not itself complicate the course of IBD. In cases of a severe relapse or an occurrence of complications in these patients, careful multidisciplinary cooperation is required, especially between the gastroenterologist, surgeon, radiologist, and gynaecologist. Surgical treatment is required only in cases of acute complications of IBD (such as acute severe colitis resistant to medical therapy, perianal abscess, and complications of IBD in the sense of such acute abdomen events as perforations, ileus due to a stenosis, or massive haemorrhage).

In recent years, biomarkers have taken a central place in the assessment of cardiovascular diseases – from prediction to management and prognosis. On the other hand, enough evidence exists to assume that hypertensive disorders of pregnancy share a certain connection with cardiovascular diseases – from common risk factors and underlying mechanisms to the presence of a higher risk for women for the development of a great number of cardiovascular diseases, such as arterial hypertension, coronary atherosclerosis, stroke, peripheral artery disease, venous thromboembolism, and even a higher cardiovascular mortality. The key to a better understanding of the unfavorable cardiovascular profile of women with a hypertensive disorder of pregnancy may lie in their assessment with biomarkers, typically used in the field of cardiology. In this review, we have included studies investigating the use of cardiovascular biomarkers during or after a hypertensive pregnancy, namely, natriuretic peptides, high-sensitivity cardiac troponins, growth/differentiation factor 15 (GDF15), soluble suppression of tumorigenicity-2 (sST2), and galectin-3.

We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, which was subsequently treated endoscopically. Fish bones are one of the most commonly encountered swallowed foreign bodies. However, involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult, and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis, and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.

Background: Supplementary dietary fiber and probiotics may improve bowel symptoms due to changes in microbiome and fermentation. The aim of the study was the evaluation of symbiotic with psyllium, ColonFit, in patients with functional colonic diseases. Patients and Methods: A prospective observational study in patients with irritable bowel syndrome, functional constipation and functional diarrhea for a 4-week intake of ColonFit 10 g daily. The type and severity of bowel symptoms (scale 1–5), number and consistency of stool and quality of life features were analyzed in subgroups according to dominant initial symptoms. Results: Complete data were available from 110 patients (mean age 49.9 ± 15.3 years, 58.2% females). Constipation related symptoms were predominant in 46 (41.8%) patients, diarrhea in 28 (25.5%) and mixed type in the rest. The symptoms in constipation predominant group were more severe than in others. The significant change in softening of stool consistency (from 1.9 to 3.8 in Bristol stool scale; p < 0.001), an increase in spontaneous bowel movements (from 3.1 to 5.6× weekly; p = 0,001) and reduction of incomplete bowel movements of 40% and abdominal pain of 42% were observed in constipated patients. The reduction in a number of bowel movement per week (from 17.8 to 13.6; p = 0.001) and improvement of abdominal cramps by 27% and reduction of dietary limitations by 30% were recorded in diarrhea subgroup. The beneficial effect lasted for a two-week follow up after the discontinuation of ColonFit use. Conclusion: The ColonFit use was most beneficial in constipated patients. The improvement of several symptoms was observed in other subtypes of irritable bowel syndrome without any worsening of troubles. The use of the combination of psyllium, inulin and probiotics may offer an effective alternative for the management of functional bowel diseases.

Background Metabolic syndrome is a serious societal problem worldwide. In the Czech Republic more than 30% of the adult population are sufferers. The role of recurrent acute pancreatitis in the induction of chronic pancreatitis, following the socalled „mechanistic definition“ of chronic pancreatitis, has been unequivocally confirmed. However, there are a number of factors that may contribute to the development of chronic pancreatitis. The first aim of the study was to determine whether the metabolic syndrome may affect the development of chronic pancreatitis. The second question we asked ourselves was whether even one acute attack of pancreatitis could be an inductive factor in chronic pancreatitis. Methods Based on data obtained retrospectively from a total of 264 people diagnosed with chronic pancreatitis in 4 centers, a total of 59 people (22.3%) diagnosed within 36 months of a first attack of acute pancreatitis was obtained. Etiologies of either genetically induced pancreatitis or autoimmune pancreatitis were excluded. Diagnostics to identify the presence of metabolic syndrome were run on the 59 persons so obtained using the criteria from the socalled „harmonized“ definition of 2009 (obesity, arterial hypertension, hypertriglyceridemia, type 2 diabetes mellitus and a decreased level of HDL cholesterol). Results Comparing the findings of the individual components of metabolic syndrome in persons with chronic pancreatitis after a 1st attack of acute pancreatitis with the metabolic syndrome and in persons with chronic pancreatitis after the 1st attack of acute pancreatitis but without metabolic syndrome, a statistically significant difference in obesity was found (82.5% vs. 28.5%), hypertriglyceridemia (82.3% vs 17.8%) and arterial hypertension (70.5% vs 21.4%). The interval during which chronic pancreatitis occurred after acute pancreatitis averaged 12 months (10-14 months) in subjects with metabolic syndrome, whereas in the group without metabolic syndrome the interval was longer, 20 months (16-29 months). Conclusion Our results show that even one attack of acute pancreatitis (regardless of etiology) can be an inductive factor in chronic pancreatitis. The presence of metabolic syndrome can accelerate the development of chronic pancreatitis after one has had acute pancreatitis.

Hashimoto thyroiditis is the most common thyroid disease. This form of pathology has a diverse clinical picture, including neuropsychiatric disorders. There are frequent cases of comorbidity of autoimmune thyroiditis and psychiatric forms of pathology, along with such a nosological entity as Hashimotos encephalopathy (aka: Steroid-responsive encephalopathy of autoimmune thyroiditis), characterized by an increased level of antithyroid autoantibodies and various mental disorders, with still unclear pathogenesis. The question arises, how to regard patients with psychiatric disorders and Hashimoto thyroiditis either as patients having autoimmune thyroiditis, comorbid with psychiatric forms of pathology, or as patients with Hashimotos encephalopathy? We studied groups of patients with autoimmune thyroiditis free from any psychiatric disorders, autoimmune thyroiditis comorbid with psychiatric forms of pathology, and a group of healthy donors similar as regards to their age and sex. We also studied medical history, clinical manifestations of the disease, instrumental data and the serum levels of thyrotropin, thyroid hormones, various antithyroid autoantibodies, and prolactin. We analyzed the correlation of laboratory and instrumental parameters and clinical data in all groups of patients. Therewas a significant relationship (p 0,05) between various psychiatric symptoms and a decreased level of free thyroxine, an increased level of thyroid stimulating hormone (TSH), an increased level of prolactin and an increased volume of a thyroid gland. Asignificant relationship (p 0,05) was also found between various symptoms of hypothyroidism and a decreased level of free triiodothyronine (FT3), an increased level of antibodies to thyroglobulin (anti-TG Ab), and an increased level of antibodies to thyroid peroxidase (anti-TPO Ab).

Celiac disease is an immune mediated entheropathy triggered by gluten in genetically predisposed individuals. Patients with celiac disease are at a higher risk of gastrointestinal malignancies. Diagnosis at an advance stage is one of the factors of an unfavorable prognosis of these complications. Our patient is a woman who was diagnosed with celiac disease at 53 years of age. After two years on a gluten-free diet she developed sideropenic anemia. No source of bleeding was found on the esophagogastroduodenoscopy or colonoscopy. Video capsule endoscopy revealed exulcerated bleeding stenosis in the jejunum, in front of which the capsule lodged. There were no signs of infiltration on simultaneous CT enterography. The patient was operated on and the infiltration of the jejunum was resected. The specimen was evaluated by a histopathologist as a moderately differentiated adenocarcinoma. Due to the risk factors, the patient received adjuvant chemotherapy. The knowledge of the malignant complications of celiac disease, their risk factors and the possibilities of modern enteroscopic methods could help in the early diagnosis and improvement of the prognosis of these diseases. Due to a lack of data and an absence of guidelines, treatment of a small bowel adenocarcinoma is based on an expert agreement and guidelines for colon cancer. Surgical treatment is the only potentially curative option. For stage II with risk factors and stage III adjuvant chemotherapy should be considered.

Refluxni choroba jicnu (gastroesophageal reflux disease - GERD) je multifaktorialni onemocněni, na kterem se mimo jine podili i geneticka predispozice jedince. Při diagnostice GERD a jejich komplikaci, jako je Barrettův jicen (Barrett's esophagus - BE) a adenokarcinom jicnu (esophageal adenocarcinoma - EAC), jsou standardně využivany endoskopicke metody a histologicke vysetřeni. Pro screening BE u osob se zvýseným rizikem vzniku tohoto onemocněni i při sledovani rozvoje dysplazie BE by vzorky jicnove sliznice mohly být odebrany pomoci novodobých neendoskopických postupů, kterými lze minimalizovat invazivnost zakroku a zlepsit compliance a adherenci pacientů k lecbě. Neendoskopicky odebraný vzorek sliznice jicnu je možne stejně jako vzorek ziskaný endoskopickou biopsii analyzovat jak imunohistochemickým vysetřenim, tak provest molekularně biologickou analýzu na specificke biomarkery. Markery jako caudal type homeobox 2 (CDX2) a protein p53 již nasly sve uplatněni v diagnostice GERD, a proto se výzkum v poslednich letech zaměřuje na identifikaci dalsich biomarkerů, pomoci kterých by bylo možne spolehlivě predikovat vznik a rozvoj BE nebo EAC. Tento přehledový clanek shrnuje informace o modernich neendoskopických metodach odběru vzorků sliznice jicnu a o biomarkerech, ktere byly v souvislosti s predikci a diagnostikou BE a EAC studovany v neendoskopicky odebrane tkani a maji potencial pro využiti v klinicke praxi.

Uvod: Konfokalni laserova endomikroskopie využivajici sondy (probe-based confocal laser endomicroscopy - pCLE) je nova diagnosticka metoda urcena pro endoskopii, ktera umožňuje mikroskopicke vysetřeni na buněcne urovni v realnem case. Endoskopicka diagnostika casných neoplastických lezi distalniho jicnu neni snadna a casto tyto leze mohou být přehlednuty. Cilem pilotni studie bylo ziskat charakteristicke pCLE obrazy u onemocněni jicnu pro dalsi studie a vyhodnotit možnou roli pCLE v diagnostice dysplastickeho Barrettova jicnu (Barrett´s esophagus - BE) a casneho adenokarcinomu jicnu (esophageal adenocarcinoma - EAC). Metody: Nejprve byl vyhledan přehled soucasne literatury s nasledným nastudovanim předchozich publikaci obsahujici pCLE obrazy a jejich klasifikaci u onemocněni jicnu. V druhe fazi byli do teto pilotni studie zařazeni pacienti s onemocněnim jicnu, kteři podstoupili horni endoskopicke vysetřeni s pCLE. Zařazena byla i zdrava kohorta osob. Výsledky: Od ledna roku 2019 do cervence roku 2019 bylo vysetřeno celkem 14 pacientů v ramci teto prospektivni pilotni studie: 3 pacienti s refluxni ezofagitidou, 4 s BE, 3 s EAC a 4 zdrave osoby. Byla provedena endoskopie s pCLE a ziskany charakteristicke pCLE obrazy. Spravna diagnoza byla endoskopistou stanovena pomoci pCLE (real-time) celkem u 11 ze 14 vysetřených pacientů (78,6 %). Zavěr: Bylo možne ziskat typicke pCLE obrazy u onemocněni jicnu během standardni endoskopie s využitim capu. pCLE se zda být novou slibnou metodou k surveillance BE a detekci casných neoplastických lezi. Na druhou stranu je zapotřebi vice dalsich studii a dat na větsim souboru pacientů.