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Summary: Background: Compared to other European countries, the Czech Republic has long been one of the countries with high rates of incidence and mortality of colorectal cancer. The screening program was implemented in 2000 and has become an essential part of prevention policy in the Czech Republic. Continuous monitoring of the entire screening process is necessary to ensure high quality and the resulting success of the program. The aim of the paper is to present the current results of the National Colorectal Cancer Screening Program using selected indicators in accordance with established recommendations. Material and Methods: The analysis was performed on data on preventive colonoscopies performed in Centers for screening colonoscopy (Centers) in 2021, with selected performance indicators being evaluated (number of preventive colonoscopies, adequate bowel preparation, caecal intubation rate and adenoma detection rate). The resulting performance indicators were evaluated by the published recommendations of the Czech Gastroenterological Society to point to the results of the program as a whole, not to assess individual Centers. Results: The majority (94.7%) of the Centers achieved the basic performance indicator (number of preventive colonoscopies). The performance indicator of adequate bowel preparation was met by 83.6% of Centers (the average proportion of colonoscopies with adequate bowel preparation in the Czech Republic is 93.8%). The optimal proportion of caecal intubation (90.0%) was reached by 87.2% of Centers in 2021. Only 16 Centers (8.5%) did not meet the adenoma detection rate indicator, but a high variability was observed across the Centers (11.6% to 68.2%) – a similar situation was observed in evaluation by gender and indication. A relatively low adenoma detection rate in follow-up colonoscopies after positive FOBT could be related to high and variable FOBT, which may indicate redundant colonoscopies and overburden the Centers. Conclusion: Some Centers do not reach the reference values for performance indicators according to reference values. It is necessary to continue monitoring performance indicators at the level of individual Centers to improve the quality of the entire program. Key words: colorectal cancer – screening – performance indicators – colonoscopy

Background Coverage by examinations is a crucial indicator of the future impact on the burden of colorectal cancer (CRC). The study aimed to evaluate coverage by examinations associated with CRC screening and early cancer detection of CRC in the Czech Republic. The burden of CRC was also assessed. Methods The novel nationwide administrative registry with individual data (period 2010–19) was used to evaluate coverage by examinations for screening faecal occult blood test and colonoscopy. In the second step, additional examinations for early CRC detection were included in the coverage calculation (complete coverage). Age-specific trends in CRC incidence (period 1977–2018) were investigated using Joinpoint regression. Results Coverage by screening examinations within recommended interval was around 30%. Complete coverage reached >37% and >50% at the 3-year interval. The coverage by examinations for the non-screening population aged 40–49 years was almost 4% and 5% (most of them were colonoscopies) at the 3-year interval. In age groups aged ≥50 years, we observed a significant annual decline, especially in the 50–69 age group, with recent annual decreases reaching up to 5–7%. The change in trend and the recent decline were also observed in the age group 40–49. Conclusions More than half of the target screening population was covered by examinations potentially associated with early detection and subsequent treatment of colorectal neoplasms. The substantial coverage by potentially prophylactic examinations might be an explanation for the considerable decrease in CRC incidence.

Objectives. The BODE (BMI, Obstruction - FEV1, Dyspnoea - mMRC, Exercise - 6-MWT) and the ADO (Age, Dyspnoea - mMRC, Obstruction - FEV1) indices are widely used prognosis assessment tools for long-term mortality prediction in COPD patients but subject to limitations for use in daily clinical practice. The aim of this research was to construct a prognostic instrument that prevents these limitations and which would serve as a complementary prognostic tool for clinical use in these patients.Methods and Participants. The data of 699 COPD subjects were extracted from the Czech Multicentre Research Database (CMRD) of COPD patients (the derivation cohort) and analysed to identify factors associated with the long-term risk of mortality. These were entered into the ROC analysis and reclassification analysis. Those with the strongest discriminative power were used to construct the new index (CADOT). The new index was validated on 187 patients of the CIROCO+ cohort (Netherlands; the validation cohort).Results. The CADOT was constructed by adding two newly identified prognosis-determining factors, chronic heart failure (CHF) and TLCO, to the ADO index. In a head-to-head comparison, the CADOT index showed highest c-statistic values compared to the BODE and ADO indices (0.701 vs 0.677 vs 0.644, respectively). The prognostic power was more definitive when applied to the Dutch validation (CIROCO+) cohort (0.842 vs 0.799 vs 0.825, respectively).Conclusions. The CADOT index has comparable prognostic power to the BODE and ADO indices.The CADOT is complementary/an alternative to the BODE (if 6-MWT is not feasible) and ADO (with less dependence on the age factor) indices. CMRD research project has been funded by Ministry of Health of the Czech Republic (15/14/NAP, 5/15/NAP, UHHK 00179906, MH CZ-DRO FNBr65269705), and the Charles University Czech Republic (PROGRES Q40, and PROGRES Q42), and a consortium of several pharmaceutical companies (Angelini, AstraZeneca, Boehringer Ingelheim, Cipla, CSL Behring, GSK, Novartis, and Sandoz). All companies supported the CMRD project via unrestricted research grants. The sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. The opinions, results, and conclusions reported in this article are independent of the funding sources. The authors would like to thank to physicians and their nursing staff (not mentioned as authors) of all participating centers of the CMRD of COPD, for assistance with data collection, namely: Petra Vogelova, Tomas Dvorak – Pulmonary Department, Hospital Mlada Boleslav, Petr Safranek – Pulmonary Department, University Hospital, Pilsen, Ondrej Sobotik – Pulmonary Department, University Hospital Motol, Prague, Rostislav Simek – Pulmonary Department, Regional Hospital of T. Bata, Zlin, Jaroslav Lnenicka, Blanka Snelerova – Pulmonary Department, Masaryk Hospital, Usti nad Labem, Zuzana Liptakova – Pulmonary Department, Ceske Budejovice Hospital, Libor Nevoranek, Eva Kocova, Michal Kopecky, Sarka Pracharova, and Lukas Varhanik – University Hospital Hradec Kralove, Lucie Heribanova – Pulmonary Department, Thomayer Hospital, Prague, Katerina Neumannova – Palacky University, Olomouc and Milada Sipkova – Pulmonary Department, Liberec Hospital.

Background Several registries of idiopathic pulmonary fibrosis (IPF) have been established to better understand its natural history, though their size and duration of follow-up are limited. Here, we describe the large European MultiPartner IPF Registry (EMPIRE) and validate predictors of long-term survival in IPF. Methods the multinational prospective EMPIRE registry enrolled IPF patients from 48 sites in 10 Central and Eastern European countries since 2014. Survival from IPF diagnosis until death was estimated, accounting for left-truncation. the Cox proportional hazards regression model was used to estimate adjusted hazard ratios (HR) of death for prognostic factors, using restricted cubic splines to fit continuous factors. Results the cohort included 1620 patients (mean age at diagnosis 67.6 years, 71% male, 63% smoking history), including 75% enrolled within 6 months of diagnosis. Median survival was 4.5 years, with 45% surviving 5 years post-diagnosis. Compared with GAP stage I, mortality was higher with GAP stages II (HR 2.9; 95% CI: 2.3-3.7) and III (HR 4.0; 95% CI: 2.8-5.7) while, with redefined cut-offs, the corresponding HRs were 2.7 (95% CI: 1.8-4.0) and 5.8 (95% CI: 4.0-8.3) respectively. Mortality was higher with concurrent pulmonary hypertension (HR 2.0; 95% CI: 1.5-2.9) and lung cancer (HR 2.6; 95% CI: 1.3-4.9). Conclusions EMPIRE, one of the largest long-term registries of patients with IPF, provides a more accurate confirmation of prognostic factors and co-morbidities on longer term five-year mortality. It also suggests that some fine-tuning of the indices for mortality may provide a more accurate long-term prognostic profile for these patients., Boehringer IngelheimBoehringer Ingelheim, The EMPIRE registry is supported by a grant from Boehringer Ingelheim (since 2014). the sponsor did not have any involvement in the collection, analysis, and interpretation of the data or in the writing of or commenting on this manuscript

Decisions about the treatment of a patient with lung cancer depend on the clinical stage of the disease, morphological diagnosis, examination of predictive markers and overall clinical condition; the wishes of a well-informed patient must also be taken into account. Accurate diagnosis is essential for the future of a patient with lung cancer. The epidemiology of lung cancer is related to cigarette consumption. The risk of the disease increases with the number of cigarettes smoked. The relative risk for smokers is 22.4, for very heavy smokers with a load of more than 25 packets, it can reach up to 50. Most cases of lung cancer are caught in the advanced stages of the disease, when surgery and sometimes other active treatments are no longer possible. Searching for lung cancer in at-risk groups is essential for reducing lung cancer mortality, leading to the detection of the disease at a low stage when the tumor is operable.

Background: Research objective was to detail COVID-19’s natural trajectory in relation to the Czech population’s viral load.Methods: Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19’s impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a fourteen-day quarantine.Results: Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median–19 days). The highest viral load occurred within 0-2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients.Conclusions: No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax

Introduction Nintedanib, a tyrosine kinase receptor inhibitor, may be associated with increased bleeding risk. Thus, patients with an inherited predisposition to bleeding, or those receiving therapeutic doses of anticoagulants or high-dose antiplatelet therapy, have been excluded from clinical trials of nintedanib in idiopathic pulmonary fibrosis (IPF). Objective Our objective was to examine real-world bleeding events in patients with IPF treated with antifibrotics, including those receiving anticoagulants and/or antiplatelet therapy. Methods the European MultiPartner IPF Registry (EMPIRE) enrolled 2794 patients with IPF: group A (1828: no anticoagulant or antiplatelet treatment), group B (227: anticoagulant treatment), group C (659: antiplatelet treatment), and group D (80: anticoagulant and antiplatelet treatment). Overall, 673 (24.1%) received nintedanib and 933 (33.4%) received pirfenidone. Bleeding events and their relationship to antifibrotic and anticoagulation treatment were characterized. Results Group A patients, versus those in groups B, C, and D, were typically younger and generally had the lowest comorbidity rates. A higher proportion of patients in groups A and C, versus group B, received nintedanib. Pirfenidone, most common in group D, was more evenly balanced across groups. in patients with reported bleeding events, seven of eight received nintedanib (groups A, C, and D). Bleeding incidence was 3.0, 0, 1.3, and 18.1 per 10,000 patient-years (groups A, B, C, and D, respectively). Conclusion Real-world data from EMPIRE showed that patients on anticoagulant medications received nintedanib less frequently, perhaps based on its mechanism of action. Overall, bleeding incidence was low (0.29%: nintedanib 0.25%; pirfenidone 0.04%) and irrespective of anticoagulant or antiplatelet therapy received (P = 0.072)., Boehringer Ingelheim International GmbH (BI)Boehringer Ingelheim; Boehringer Ingelheim International GmbHBoehringer Ingelheim, This study was supported by Boehringer Ingelheim International GmbH (BI). Medical writing assistance was provided by Islay Steele, PhD, of Nucleus Global, which was contracted and funded by Boehringer Ingelheim International GmbH. Boehringer Ingelheim was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.

Skupina odborniků na CHOPN při Ceske pneumologicke a ftizeologicke spolecnosti (CPFS) připravila navrh aktualizace doporucených postupů pro lecbu stabilni CHOPN. Vědecký výbor CPFS zamýslene aktualizace přezkoumal a na zakladě toho byla vytvořena předběžna verze dokumentu. Tento dokument byl schvalen Konsenzualni konferenci CPFS v listopadu 2017. Rovněž vznikla zkracena přirucka pro prakticke lekaře (leden 2018). Zakladnim principem noveho přistupu k CHOPN je systematický popis vsech lecitelných znaků/fenotypových nalepek u každeho připadu CHOPN. CPFS definuje sest klinicky relevantnich fenotypů: frekventni exacerbace, překryv CHOPN a AB, překryv CHOPN a bronchiektazii, emfyzematický, bronchitický a fenotyp plicni kachexie. Doporuceni pro lecbu lze rozdělit na dvě casti. Prvni krok obnasi eliminaci rizikove expozice a mandatorni lecbu inhalacnimi bronchodilatancii, trenink inhalacnich technik, pravidelnou pohybovou aktivitu, pulmonalni rehabilitaci, intervence zaměřene na komorbidity a ockovani. Druhý krok zahrnuje fenotypově cilenou lecbu a peci o pacienty s respiracni insuficienci a terminalni CHOPN. Na konci tohoto clanku je popsana pilotni screeningova studie CHOPN u vysoce rizikove populace.

Background. Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with multiple clinical faces. Metabolomic profiling studies small molecules present in biological samples by combined use of chromatography with mass spectrometry. Objectives. The goal of our work was to perform a high performance liquid chromatography combined with tandem mass spectrometry (HPLC-MS/MS) metabolomic study to compare the concentrations of metabolites in COPD patients and in controls. Material and methods. Participants were recruited at the University Hospital, Hradec Kralove, Czech Republic, with the approval of the ethics committee. The analysis of blood samples was performed at Health Sciences Center (HSC) in Kuwait. The blood samples were analyzed for concentrations of acylcarnitines and amino acids by high performance liquid chromatography (Waters 2690 HPLC; Waters, Milford, USA) and a triple-quadruple tandem mass spectrometer (Quattro LC, Micromass, Manchester, United Kingdom). Results. Groups of 10 subjects with COPD and 10 healthy controls were analyzed. Carnitine analysis showed that the free carnitine to acylcarnitine ratio (CO/AC ratio) was significantly lower in COPD (0.58 mu M/L) compared to the controls (0.73 mu M/L; p = 0.002). The mean C8/C2 ratio in the COPD group was significantly higher (0.03 mu M/L) - in the control group it was 0 mu M/L (p = 0.03). Amino acid analysis showed lower levels of phenylalanine in the COPD group (22.05 mu M/L) compared to the controls (30.05 mu M/L; p = 0.008). The alanine concentrations were significantly lower in the COPD group (173 mu M/L) than in the control group (253 mu M/L; p = 0.001). The pyroglutamate levels were higher in COPD (1.58 mu M/L) than in the controls (1 mu M/L; p = 0.040). Conclusions. The carnitine and acylcarnitine levels in COPD subjects in this study possibly indicate a predisposition to atherosclerosis as a result of inadequate p-oxidation of fatty acids and show the presence of oxidative stress. Furthermore, the high sensitivity to changes in circulating amino acid levels may allow us to detect subclinical malnutrition and take early preventative interventions such as nutritional supplementation and patient education.

Kristian Brat,1 Marek Plutinsky,1 Karel Hejduk,2 Michal Svoboda,2 Patrice Popelkova,3 Jaromir Zatloukal,4 Eva Volakova,4 Miroslava Fecaninova,5 Lucie Heribanova,6 Vladimir Koblizek7 1Department of Respiratory Diseases, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic; 2Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; 3Pulmonary Department, University Hospital, Ostrava, Czech Republic; 4Pulmonary Department, University Hospital, Olomouc, Czech Republic; 5Department of Pneumology, Bulovka Hospital, Prague, Czech Republic; 6Department of Respiratory Medicine, Thomayer Hospital, Prague, Czech Republic; 7Pulmonary Department, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic Background: Respiratory parameters are important predictors of prognosis in the COPD population. Global Initiative for Obstructive Lung Disease (GOLD) 2017 Update resulted in a vertical shift of patients across COPD categories, with category B being the most populous and clinically heterogeneous. The aim of our study was to investigate whether respiratory parameters might be associated with increased all-cause mortality within GOLD category B patients. Methods: The data were extracted from the Czech Multicentre Research Database, a prospective, noninterventional multicenter study of COPD patients. Kaplan–Meier survival analyses were performed at different levels of respiratory parameters (partial pressure of oxygen in arterial blood [PaO2], partial pressure of arterial carbon dioxide [PaCO2] and greatest decrease of basal peripheral capillary oxygen saturation during 6-minute walking test [6-MWT]). Univariate analyses using the Cox proportional hazard model and multivariate analyses were used to identify risk factors for mortality in hypoxemic and hypercapnic individuals with COPD. Results: All-cause mortality in the cohort at 3 years of prospective follow-up reached 18.4%. Chronic hypoxemia (PaO2 7.0 kPa) and oxygen desaturation during the 6-MWT were predictors of long-term mortality in COPD patients with forced expiratory volume in 1 second ≤60% for the overall cohort and for GOLD B category patients. Univariate analyses confirmed the association among decreased oxemia (7.0 kPa), oxygen desaturation during 6-MWT and mortality in the studied groups of COPD subjects. Multivariate analysis identified PaO2

Chronic obstructive pulmonary disease (COPD) is a leading cause mortality and morbidity globally, with permanently growing prevalence. Expressive underdiagnosis and undertreatment is a general features across all European countries. Individuals with undiagnosed, symptomatic COPD had significantly increased risk of exacerbations, pneumonia, and death. Early smoking cessation is able to reduce the mortality and morbidity burden of newly diagnosed COPD individuals. These findings suggest that better initiatives for early diagnosis and early treatment of COPD are needed. A clear diagnosis of COPD requires post-bronchodilator spirometry in symptomatic mid-elderly (more than 40) aged subjects with long-lasting inhalation exposure to known risk factors.Key words: COPD - morbidity - mortality - screening - spirometry - underdiagnosis.

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAIN, WOS: 000507372406214, [No abstract available], European Respiratory Soc, Boehringer IngelheimBoehringer Ingelheim, The EMPIRE registry is supported by Boehringer Ingelheim

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAIN, WOS: 000507372402280, [No abstract available], European Respiratory Soc

To describe the use of regorafenib for the treatment of metastatic colorectal cancer (mCRC) in clinical practice in the Czech Republic, and to describe the clinical outcomes of patients in terms of safety and survival.The data of patients treated with regorafenib were extracted from the national CORECT registry. The CORECT registry is a non-interventional post-marketing database, gathering information about patients with CRC and treated with targeted agents. Twenty oncology centres in the Czech Republic contributed to this registry. Collected data included patients' characteristics, disease history, cancer treatments, response to treatments and safety.A total of 148 patients treated with regorafenib in clinical practice were analysed. At regorafenib initiation, almost all patients were fully active or slightly restricted in physical activity. Regorafenib was not administered as first-line treatment in any patient. Median progression-free survival was 3.5 months and median overall survival was 9.3 months. One-year survival rate was 44.6 %. Four partial responses were observed and 51 stable diseases. Progression was observed in 66 patients (44.6 %). The main reported adverse events were skin toxicity (5.4 %) and fatigue (2.0 %).Regorafenib is a well-established treatment for pretreated patients with mCRC, however real-life data are scarce. Our results demonstrated slightly better efficacy of regorafenib and better safety profile in patients with mCRC compared to the randomised trials.

Karcinom plic zaujima předni mista jak v incidenci, tak v mortalitě nadorových onemocněni celosvětově i v Ceske republice. V poslednich letech zaznamenala lecba NSCLC prudký rozvoj. Již v době stanoveni diagnozy je snahou co nejpřesněji urcit morfologickou diagnozu a pokud je to indikovano, provest geneticke testovani. Toto plati předevsim o nedlaždicobuněcných NSCLC. V roce 2013 byla publikovana ucinnost a bezpecnost pokracovaci udržovaci lecby (continuation maintenace) monoterapii pemetrexedem a diky pozitivnimu výsledku je tato lecba možna od května 2013 v Ceske republice. V nasi praci prezentujeme soubor 134 hodnocených pacientů, kteři absolvovali výse uvedenou lecbu. V realne klinicke praxi v Ceske republice bylo dosaženo lecbou pemetrexedem v pokracovaci udržovaci lecbě lepsich výsledků než v registracni studii a lecba byla velmi dobře snasena. Zatim median celkoveho přežiti (OS) byl stanoven na 23,5 měsice.

Idiopathic pulmonary fibrosis (IPF) is one of the most common interstitial lung diseases with limited survival. The effect of IPF therapy in patients with severely impaired lung function is not well established. The aim of this study was to characterize IPF patients with a forced vital capacity (FVC)

Background and Aim: From October 2013 there is a possibility to treat patients with NSCLC and with activated epidermal growth factor receptor (EGFR) mutations with three TKI in the Czech Republic. We have tried to find differences among patient groups treated with single TKI in 1st line of treatment. Patients and methods: Only patients with EGFR mutation and in which 1st line treatment started in October 2013 until October 2017 were included in analysis. We analysed 347 patients (gefitinib - 164 patients, afatinib - 130 patients, erlotinib - 53 patients). Results: Between these three groups of patients there was no statistically significant difference in sex (p=0.988), in smoking habits (p=0.549), in type of EGFR mutation (p=0.200), in adenocarcinoma proportion (p=0.256). There was statistically significant difference according to age (p=0.001), PS ( Conclusion: We have not found any important difference in basic characteristic of patients treated in 1st line treatment with TKI (sex, smoking, histology and type of EGFR mutation) except for the age – patients treated with afatinib were younger. We have not found any important difference in response to treatment, in disease control and OS. We found a significant difference in PS segmentation, in occurrence of adverse events and PFS.

Aim: To assess the nutrition and muscle mass loss in patients with severe COPD and its phenotypes. Methods: We analysed baseline data of patients with severe COPD from the Czech Multicenter Research Database. We assessed BMI (Body Mass Index), FFMI (Fat Free Mass Index) measured by Skinfold Anthropometry and MAMC (Mid-arm muscle circumference) in non-dominant upper arm. Results: A total of 337 patients were included in the analysis, 248 men, mean age 66.7 years, mean FEV1 44.9%, average CAT 16.8. There were 10.1% patients with cachexia, 5.1% with underweight, 31.2 % patients were obese. Total of 79.5% patients had normal muscle mass, 20.5% had muscle mass loss. Emphysematic phenotype was associated with cachexia (p=0.02), underweight and muscle mass loss (p=0.002), obesity was less common in emphysematic phenotype (p Conclusion: Poor nutrition status and non-physiological muscle mass loss are associated with certain COPD phenotypes, with worse lung function and with higher frequency of symptoms and exacerbations. Prospective follow-up and prognostic evaluation of nutritional status will continue.

Introduction: According to the GOLD 2017 guidelines, the assessment of COPD is based on symptoms and exacerbation history. Currently, major part of COPD patients is classified stage B. This fact stresses the need for identifying risk factors of mortality in subpopulations of COPD patients. Aims: Our aim was to identify risk factors predictive of severe outcome in COPD patients. Methods: Prospective data from the Czech research database of COPD were analyzed with emphasis on respiratory parameters. Patients that completed blood gas examination and 36 months of follow-up were included. Kaplan-Meier survival plots were calculated for each pre-defined parameter (oxemia, capnemia, hemoglobin saturation, minimal saturation at rest or during 6MWT) for COPD patients overall and for subgroups with stage B and D. Analyses were performed for both GOLD 2016 and 2017 guideline. Results: To date, 722 patients were included in the registry. According to GOLD 2016 guidelines, 20.2% of these patients were classified stage B. Following the GOLD 2017 guidelines, the portion of stage B patients was 53.0%. Overall 391 patients met the inclusion criteria for our study. We have found significant differences in 3-year mortality in patients with COPD stage B if moderate hypoxemia (p Conclusion: Moderate hypoxemia, decreased saturation and minimal saturation at rest or at 6MWT predict outcome in patients with COPD stage B.

Background and Aim: From October 2013 there is a possibility to treat patients with NSCLC and with activated epidermal growth factor receptor (EGFR) mutations with three TKI (afatinib, eriotinib, gefitinib) in the Czech Republic. We have tried to find differences among patient groups treated with single TKI in 1st line of treatment. Patients and methods: As data source we used the TULUNG registry, which is focused on the data collection of patients with NSCLC treated with target therapy in the Czech Republic. We analysed 232 patients (gefitinib - 115 patients, afatinib - 77 patients, eriotinib - 40 patients.). Statistical significance was assessed using the Fisher's exact test or Kruskal-Wallis test (a=0.05).

Introduction: Physical activity is the 4 th leading risk factor for global mortality. Healthy people who have less than 5000 steps per day are very inactive. However, there is not enough information which amount of steps per day can adversely affect mortality in patients with chronic obstructive disease (COPD). This study aimed to evaluate functional status, the level of daily physical activity (DPA) in patients with COPD and assess the association between DPA and mortality in following 3 years. Methods: DPA was evaluated in 174 patients (FEV 1 = 44.6%; 66.2 years) from the Czech Multicentre Research Database of COPD. Patients wore pedometer daily for 1 month. Pulmonary functions, exercise tolerance, COPD assessment test, mortality indexes were assessed at baseline. We monitored mortality in this group in following 3 years. Results: According to ROC analysis we confirmed that less than 4000 steps per day are a limit for higher mortality in patients with severe COPD. Furthermore, lower DPA than 4000 steps per day is associated with significantly worse functional status (Table 1). Conclusion: From given results it can be concluded that maintaining DPA higher than 4000 steps per day in patients with severe COPD should be one of the most important goals of treatment to avoid functional decline and mortality in these patients.

INTRODUCTION: The individual patient prognosis after radical surgery for Non-small cell lung cancer (NSCLC) of left upper lobe remains still unclear. The purpose of this study is to evaluate the predictive value of elevated white blood cell count in peripheral blood as early indicator of postoperative NSCLC prognosis. METHODS: A retrospective statistical analysis was performed studying patients subject to radical treatment of left upper lobe NSCLC in period of five years with subsequent one to three-year monitoring of morbidity and mortality of the patient population. The statistical ROC (Receiver Operating Characteristic) analysis of the WBC count in peripheral blood third day after the operation was used to evaluate the relationship with overall survival, with respect to patients surviving for at least 24 months. RESULTS: Based on the results of the ROC analysis with a total area under the curve (AUC) of 0.67, it is possible to confirm that the WBC count established third day after the operation allows us to classify patients into groups according to the 24-month overall survival. CONCLUSION: Our findings confirm the potential of using WBC count to improve current protocols to establish postoperative prognosis for NSCLC of the upper left lobe (Tab. 2, Fig. 1, Ref. 11). Text in PDF www.elis.sk.

Pemetrexed is an intravenously administered antifolate cytostatic agent targeting several folate-dependent enzymatic pathways, widely used in the treatment of patients with advanced non-small cell lung cancer (NSCLC). It has been previously demonstrated that the superiority of pemetrexed is limited to patients with non-squamous histology. Aside from the non-squamous histology, there is still no available molecular biomarker predicting treatment efficacy of pemetrexed-based chemotherapy. The aim of our retrospective study was to evaluate the association of baseline serum levels of C-reactive protein (CRP) with outcomes in a large cohort of patients with non-squamous NSCLC treated with pemetrexed. Clinical data of 325 patients were analysed. Serum samples were collected within one week before the initiation of treatment. The median progression-free (PFS) and overall survival (OS) for patients with high CRP was 2.1 and 9.5 compared to 4.2 and 20.5 months for those with normal CRP (p=0.002 and p

Pemetrexed is an antifolate cytostatic agent targeting several folate-dependent enzymatic pathways, widely used in the treatment of locally advanced or metastatic stage non-small cell lung cancer. Aside from the non-squamous histology, there is still no available molecular biomarker predicting treatment efficacy of pemetrexed-based chemotherapy. The aim of our retrospective study was to evaluate the association of thyroid transcription factor 1 expression with outcome of a large cohort of patients with non-squamous non-small cell lung cancer treated with pemetrexed. We retrospectively analysed clinical data of 463 patients with advanced-stage non-small cell lung cancer (IIIB or IV) treated with pemetrexed-based chemotherapy. Thyroid transcription factor 1 expression was assessed using indirect immunohistochemical detection in formalin-fixed paraffin-embedded tumour tissue at the time of diagnosis. Thyroid transcription factor 1 expression was detected in the tumour tissue from 76.0% of patients, and tumours from 24.0% of patients were thyroid transcription factor 1 negative. The median progression-free survival and overall survival for patients with thyroid transcription factor 1 positive tumours were 4.8 and 11.8 months compared to 2.8 and 8.3 months for those with thyroid transcription factor 1 negative tumours (p = 0.001 and p

Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

The publication is summarizing application of biological DMARDs in autoimmune inflammatory rheumatic diseases.Up to now conventional therapy, which for example in rheumatoid arthritis was application of methotrexate (MTx) in combination with glucocorticoids, was effective, but the remission as a target was achieved in small proportion of patients and also there was little effect on structural progression of diseases. Biological therapy was great advance because response was achieved in ¾ patients who failed MTx. At present time 8 biological drugs are available. 5 are inhibitors of TNFα and 3 have different move of action. In psoriatic arthritis are beside TNF blockers available blocker of IL 17 (secukinumab, ustekinumab, apremilast). For ankylosing spondylitis is registered secukinumab.Anti-TNF therapy is relative safe but rarely serious adverse events can occur. The most important are serious infections, opportunistic infections and tuberculosis. Other adverse event includes allergic reactions and local intolerance. Increase incidence of lymphomas was not confirmed. There is probably minimal increased risk of skin melanoma and non-melanoma tumors. Benefit/risk ratio is still very positive.National registry of biological therapy ATTRA was founded 15 years ago and includes patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. In June 2016 over all 6800 patients with those diagnoses was included and actually 5194 have been treated. In registry patients are regularly followed for activity, efficacy of the drug and other events. Results of registry are sent payers for evaluations of pharmacologic parameters.

In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample.We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1mg/kg (ROC n=245) or suxamethonium 1mg/kg (SUX n=243) after propofol 2mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases.Data were analysed for 525 newborns (ROC n=263vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores7 at 1min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5min (ROC 8% vs. SUX 4.2%, P=0.1) or 10min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes.The use of rocuronium was associated with lower Apgar scores at 1min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.

The effectiveness of continuation maintenance therapy with pemetrexed versus the watch-and-wait approach was proved by a large randomised phase III trial. We focused on continuance maintenance therapy with pemetrexed in routine clinical practice in the Czech Republic.