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Chemotherapy (CHT), surgery and radiotherapy (RT) are essential modalities in the treatment of pancreatic malignancies. Their use in practice may be influenced by a number of factors.Retrospective analysis of CHT, surgery and RT indications and CHT results in patients reported with pancreatic tumor in Pilsen in 2012-2016.A total of 348 patients with median age 68 (19-89) years with newly diagnosed pancreatic tumor, resp., with histology/cytology verified carcinoma in 74.5% cases, with v. s. carcinoma without verification in 21% and with other malignancy not further analyzed here in 4.5% (mostly neuroendocrine tumor). In patients with generalized malignancy (n = 195), exploratory laparotomy was performed in 23% to get tissue samples or verify staging - palliative anastomoses were done in 25% of operated patients, CHT was performed in 29% of the generalized tumors, palliative RT of tumor was performed in 1 patient, and RT of metastases in 3 patients. In patients with local or regional nodal affection (n = 137) laparotomy was done in 59%, R0 resection in 34 (42%) of 81 operated, R1 in 6%, palliative anastomoses were done in 17% and irreversible electroporation in one patients, CHT or radiochemotherapy after R0 and R1 resections was provided in 61% operated patients. The most commonly used CHT was monotherapy with gemcitabine or FOLFIRINOX. The indication of CHT in cytology/histology verified generalized cancers and with excluding patients refusing CHT was proposed in 2012 to 16%, in 2014 to 49% and in 2016 to 84% of patients. In the case of a local or regional nodal involvement the CHT was proposed to 40, 55 and 86% of patients. Median overall survival in generalized tumor patients receiving CHT (n = 137) vs. not-receiving CHT (n = 56) was 2 vs. 8 months (p = 0.0001), and in the local or regional nodal involvement patients receiving CHT (n = 74) vs. not-receiving CHT (n = 62) was 5 vs. 16 months (p = 0.0001).CHT and surgery are the dominant treatment modalities. There has been a marked increase in the CHT and histology/cytology verifications indications, with a major factor being a clinician evaluation of a patient to be fit for CHT and its benefit or to complete pancreatic tumor verification. With still very limited results in pancreatic cancer treatment, a careful assessment of each patients indication, respecting patients desire, is always required, knowing that even in the case of advanced disease, CHT can bring benefit, albeit limited.Key words: pancreas - carcinoma - chemotherapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. This study was supported by the grant of Ministry of Health of the Czech Republic - Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806).Submitted: 13. 3. 2018Accepted: 18. 4. 2018.

Renal cell carcinoma (RCC) accounts for 2-3% of all malignant tumours. Metastatic RCC (mRCC) is commonly treated with tyrosine kinase inhibitors (TKI). Effective TKIs administration can be achieved only by accurate prediction of therapeutical response. Therefore, the aim of this study was to analyse papers concerning predictive potential of microRNA (miRNA).We chose seven candidate miRNAs and analysed their expression on 44 patients divided into cohort with poor and good response to sunitinib treatment. Patients were divided into two groups according to progression-free survival. RNA from tissue samples was isolated and expression of selected miRNAs was measured using quantitative PCR with miRNA-specific TaqMan probes.We successfully validated two miRNAs to be differentially expressed in responding and non-responding patients to sunitinib treatment. Other analysed miRNAs have not shown predictive potential.From miRNAs studied so far, two miRNAs had predictive value according to present study.Key words: microRNA - renal cell carcinoma - sunitib The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Supported by Ministry of Health of the Czech Republic, grant No. 15-34678A. All rights reserved.Submitted: 19. 3. 2018Accepted: 20. 3. 2018.

Smart cities employ creativity of the population for innovations supporting social and economic development. In this context, this paper explores the role of framework conditions on special supply effects of university hospitals, which can invite further research institutions for intense collaboration, thereby stimulating innovations. The case study, comparing a hospital in Russia with one in Germany, is based on the concept of the employment multiplier. The results show that exogenously given, but, more importantly, also modifiable framework conditions lead to large differences regarding the employment multiplier. Thus, it should be the concern of smart cities to make smart use of their institutions, such as university hospitals, by adjusting the conditions, under which they are operating. © 2018 Institute of Physics Publishing. All rights reserved.

Breast cancer is the most common malignant disease in women and represents a worldwide problem. Up-to-date diagnostics methods, mammography screening and complex treatments have resulted in a substantial reduction of mortality rates. However, the incidence of the disease keeps growing constantly, although in a moderate way. The struggle against this disease has several levels, such as prevention, primary tumour therapy as well as the management of recurrent or generalized disease. Therefore, it is very significant to evaluate the prognosis on the basis of biological characteristics of the tumour and to determine the right individual therapy in each patient.Our aim was to determine a group of patients with malignant breast disease based on biological characteristics of the tumour who can be treated without axillary exenteration even with a metastasis in the sentinel lymph node, thereby reducing the morbidity associated with this surgery, without worsening the prognosis.The research project lasted from June 2012 to June 2015. It was a prospective randomized study where the main investigated group consisted of women with primarily surgically treated mammary cancer undergoing sentinel lymph node biopsy (SNB) during their surgery. These patients were divided into three groups: group 1 - positive SNB without axillary exenteration (axillary dissection - AD); group 2 - positive SNB with AD; and group 3 - negative SNB. Group 4 consisted of patients with primarily performed AD. We investigated statistically significant prognostic factors of metastatic lymph nodes and early disease progression. The results were statistically processed and differences between individual groups were evaluated, determining prognostically usable biological characteristics of the tumour in connection with metastases in lymph nodes and progression-free survival.The study included 214 patients with breast cancer. No metastases of axillary lymph nodes were found in 136 patients (64%); on the other hand, 78 patients (36%) had positive axillary lymph nodes and included: 28 (13%) patients with a micrometastasis in the sentinel lymph node; 38 (17%) patients with 13 positive lymph nodes; 8 (4%) patients with 49 positive lymph nodes; and 4 (2%) patients had more than 10 metastatic lymph nodes. A statistically significant difference with respect to metastatic lymph node involvement was found for the tumour size, expression of oestrogen receptors, proliferative activity and grading.The following prognostic factors of metastatic lymph nodes and early disease progression were shown to be statistically significant: tumour size over 2 cm, negative expression of oestrogen receptors, tumours with moderate and high proliferative activity, and tumour grades G2 and G3. In the course of the three years of this study, no regional recurrence was found in axillary lymph nodes in any patient, and therefore, it clearly follows that the completion of axillary exenteration can be omitted in the case of tumour sizes below 2 cm, present expression of oestrogen receptors, low proliferative activity and grade 1 even if one or two positive sentinel lymph nodes are present, provided that adjuvant radiation therapy can be used. Also, axillary exenteration is not needed if a micrometastasis or isolated tumour cells are found in the sentinel lymph node.Key words: breast cancer - sentinel lymph node biopsy - axillary exenteration - prognostic factors.

Parkinson's disease (PD) is a genetically heterogeneous disorder and new putative disease genes are discovered constantly. Therefore, whole-exome sequencing could be an efficient approach to genetic testing in PD. To evaluate its performance in early-onset sporadic PD, we performed diagnostic exome sequencing in 80 individuals with manifestation of PD symptoms at age 40 or earlier and a negative family history of PD. Variants in validated and candidate disease genes and risk factors for PD and atypical Parkinson syndromes were annotated, followed by further analysis for selected variants. We detected pathogenic variants in Mendelian genes in 6.25% of cases and high-impact risk factor variants in GBA in 5% of cases, resulting in overall maximum diagnostic yield of 11.25%. One individual was compound heterozygous for variants affecting canonical splice sites in VPS13C, confirming the causal role of protein-truncating variants in this gene linked to autosomal-recessive early-onset PD. Despite the low diagnostic yield of exome sequencing in sporadic early-onset PD, the confirmation of the recently discovered VPS13C gene highlights its advantage over using predefined gene panels.

Oral mucositis, mTOR associated stomatitis, is a major complication in everolimus (EVE) treatment with an incidence of 44-64%. The management of it in the daily practice has not been described enough, so far.Retrospective analysis of patients treated with EVE in 2016 at our center, n = 42 patients (69% female), median age 66 (37-81) years, breast cancer in 20 (48%) and renal cell carcinoma in 22 (52%), starting EVE dose of 10mg/day in 34 (81%) and 5mg/day in 8 (19%) patients.Discomfort and/or dysgeusia without mucosa defects (grade 1 NCI-CTC) was in 4/34 (12%) patients, mucosal defects without oral intake limitation (grade 2) in 6/34 (17.5%), mucosal defects limiting oral intake (grade 3) in 7/34 (20.5%) patients.in grade 1 EVE dose reduced to 5mg/day in 1/4 affected patients, in grade 2 locally administered dexamethasone solution recommended in 2/6, reduction of EVE to 5mg/day in 4/6 (in two cases the reduced dose left because of complications recurrences), in grade 3 locally administered dexamehasone solution recommended in 5/7, transient reduction of EVE to 5mg/day in 1/7, permanent reduction of EVE in 5/7 (recurrent aphthous lesions), EVE terminated in 1/7. In patients with EVE starting dose of 5mg/day there was one case (1/8, 12.5%) of grade 2 complication requiring no intervention. The complications developed within 2-20 weeks after EVE initiation (median of 8 weeks).The incidence of stomatitis and its severity in this cohort is comparable with published trials data, it confirms the significant incidence of damage affecting the quality of life, oral intake and anti-cancer treatment in daily practice. The interventions used in groups of similarly affected patients appears slightly heterogeneous, influenced by individual physician approach. There is tendency not to interrupt the EVE treatment and keep it either in a dosage of 10 or 5mg/day if the oral damage is tolerable. Local treatment with dexamethasone is not yet fully exploited.Key words: everolimus - stomatitis - mucositis - oral cavity Supported by the grant of Ministry of Health of the Czech Republic - Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806) and National Sustainability Program I (NPU I) No. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 27. 2. 2017Accepted: 26. 3. 2017.

During a routine trip to a horse slaughterhouse, we found bilateral ovarian teratoma. Macroscopic findings were confirmed by the presence of hair, bones, and cartilage. Under microscopy, these tumors had mature foreign tissues as stratified squamous and respiratory epithelia, sebaceous and sweat glands, as well as follicular endocrine cells, inflammatory cells, hepatocytes, and hyaline cartilage.

The limits of liver surgery are restricted today by the functional reserves of remnant parenchyma. The aim of this article was to acquaint the general surgical and medical public with the results of experimental liver regeneration stimulated by cytokines and thus to enhance their effort to carry on with implementing the research results in clinical practice.Authors present their experimental model of liver regeneration after ligation of portal branches for caudate and right lateral, and right medial liver lobes. The regeneration was induced by application of TNF-alpha and IL-6 into the non-occluded portal branches, and compared with the results of other experimental teams.The absolute volume of hypertrophic lobes increases after application of TNF-alpha more rapidly, whereas in the control group, practically no changes were recorded in hypertrophic liver lobes volumes in first three days. The achieved acceleration of growth of hypertrophic liver lobes after application of TNF-alpha and IL-6 confirmed the key role of studied pleiotropic cytokines in the priming of liver parenchyma regeneration after portal vein ligation (Fig. 3, Ref. 26).

A total of 58 children is referred to with fractured growth plates of the distal forearm, proximal humerus, radial condyle of humerus, ulnar epicondyle of humerus, distal tibia, proximal tibia and the distal femur. The related injuries are divided in accord with Salter-Harris classification. The treatment of epiphyseolyses is concerned together with summarizing its results and the appropriate experience. In addition, the indications for both conservative and surgical approaches are delimitated in treating these injuries.

The experience is summarized in using the method of external fixation (Stuhler-Heise from Aesculap, Poldi 7, Ilizarov's compressory distractive devices) in the traumatology of extremities within 5-year lasting period. Starting from june 1985 to July 1990, the amount of 90 open fractures of long bones has been managed (10.2% of all fractures admitted). Open fractures related to III. grade by Gustilo's classification were 20 in number, i.e. 22.0% of all open fractures admitted with anatomical distribution as follows: 50% crural, 25% humeral, 15% forearm and 10% femoral locations. The EF device was applied in 11 cases, i.e. 55%. Primary amputations were done in 4 cases, i.e. 20%. The EF application period averaged for 64 days. One case showed primary healing of EF treated fractures. The remaining cases attributed an exchange of the type of osteosynthesis or were supplemented with plastic surgery on the soft tissues and bone. Another group of 36 pseudoarthroses of long bones were operated on within the mentioned period, from them 9 cases as infected ones were treated with EF method. Once the infection has been healed, the authors proceeded with surgery and EF exchange in all cases when treating pseudoarthroses. Third--the group of 18 nonstabile intraarticular fractures of distal radius treated by means of EF is presented. The advantages of individual EF methods are discussed, and the comprehensive care approaches are presented in documental groups of injuries as illustrated with the short case-reports.

Stressory reactions in surgical patients are studied as the main adaptative reaction occurring in loads both in physiological limits and graded measure, where the reaction itself appears to action as a pathological nuisance. The human stressors are reviewed as well as up-to-date data on the pathophysiology, diagnostics and prevention of stressory reaction including the therapeutical measures in order to prevent the development of organ damages with graded anxious reaction. Of special attention are interrelations of neurohumoral and immune reactions in syndromes of the so-called acute phase holoorganic reaction in the response of the organism on the graded aggression. In addition, the multifactorial stress is scrutinised in detail as the patient goes through the diagnosis and treatment with both its objectivation and minimalization. In conclusion, the modifications are mentioned of the course of stressory reaction in endocrynopathies as well as risks and measures on how to prevent such surprising and harmful interactions.

Possible replacements in vascular reconstructive surgery are studied. The indicatory measures to vascular operations are delimited altogether summarizing the main criteria of successful grafting. The review is presented of both biological and artificial vascular replacements and their benefits and disadvantages are mentioned as well.

Authors present the initial experience with the closed locked intramedullary fixation of long bones (mainly the tibial bone) in conditions of the Teaching Hospital. Possible improvisation is reported on when lacking the foreign osteosynthetical material.

The authors discuss surgical procedures (resections and amputations) in a group of 35 patients with giant-cell bone tumours who were treated at the Orthopaedic Clinic in Hradec Králové. The diagnosis was established in cooperation by the orthopaedist, pathologist and roentgenologist. Resections were made in 24 patients, i.e. in 13 patients as primary operations, in 11 patients as secondary operations. The group comprised three tumours classified as malignant. After primary resection a relapse developed once, after secondary resection there were two relapses. Twenty-one patients, i.e. 87.5%, had no relapse. On account of two extensive relapses in soft tissues the affected extremity had to be amputated. One amputation was necessary on account of chronic osteomyelitis of the graft. The follow up period of the mentioned patients is between 3 and 26 years. The described investigation tested the possibility to extend indications of resection of giant-cell bone tumours also to conditions when the tumour perforates the affected skeleton and spreads to soft tissues in a favourable direction, i.e. muscles, without affecting important nerves and blood vessels.

The authors discuss possibilities as regards therapy, of unstable and comminutive intraarticular fractures of the distal end of the radius. They mention external fixation as one of the therapeutic methods in these fractures and describe their own experience and results with the original Ilizarov external fixation device in a group of 14 patients.