[Endoscopic harvest of great saphenous vein for infrainguinal arterial bypass: summary of our initial experience]. / Pouzití metody endoskopického odberu velké safény v periferní infrainguinální cévní chirurgii - zhodnocení iniciálních zkuseností.

INTRODUCTION: This study was undertaken to determine the feasibility of endoscopic vein harvest (EVH) for infrainguinal arterial bypass surgery. We describe our initial experience and early results of bypasses done using this minimally invasive approach. METHOD: From April 2012 to March 2015, 16 patients underwent 16 femoropopliteal bypass operations with great saphenous vein (GSV) being harvested by endoscopic technique. The indication for intervention was critical limb ischemia (Rutherford category "5") in 7 patients (43.7%) and severe intermittent claudication (Rutherford category "3") in 9 patients (56.3%). There were 14 male (87.5%) and 2 female (12.5%) patients, with a mean age of 59.9 years. Selection of patients for EVH was based on clinical and duplex ultrasound appearance of GSV. Only patients with adequate GSV were considered for EVH. We collected data regarding patients demographics, history, clinical findings, operative procedures and postoperative recovery including complications. Patients were followed at 3, 6, 12, 18 and 24 months postoperatively and yearly thereafter. Patencies were analyzed by Kaplan-Meier method. Statistical analysis was performed using IBM SPSS Statistics 21.0 software (IBM Corp, Armonk, NY). RESULTS: Endoscopically harvested GSV was utilised for formation of proximal (10; 62.5%) or distal (6; 37.5%) femoropopliteal bypass. One patient underwent conversion to open harvest after endoscopic dissection of the vein. It occurred early in our experience. All other GSV harvests were accomplished endoscopically. 2 patients (12.5%) developed postoperative surgical site infection (SSI) Szilagyi gr. II (1 patient after successful EVH - location: groin; 1 patient after conversion of EVH to open vein harvest - location: groin and vein harvest incision). Mean follow-up was 10.2 months (range 0.3 to 27.0 months). At 1 and 2 years, primary patency was 82.0% and 82.0%, assisted primary patency was 93.8% and 93.8%, and secondary patency was 100.0% and 100.0%. At 1 and 2 years, amputation-free survival was 100.0% and 100.0%. No patient died within the study period (mortality 0.0%). CONCLUSIONS: Endoscopic harvest of GSV is a minimally invasive alternative to a standard open harvest of GSV. It is a feasible option for patients undergoing infrainguinal arterial bypass. In our early experience, patencies of EVH femoropopliteal bypasses are comparable to those achieved using traditional open vein harvest technique. Combination of endoscopic vein harvest with femoropopliteal bypass formation results in a low incidence of surgical site infections. KEY WORDS: endoscopic vein harvest - great saphenous vein - peripheral vascular surgery - femoropopliteal bypass - minimally invasive vascular surgery.

[High-Resolution MR Examination of the Scapholunate Ligament using a Microscopic Coil: Comparison with Direct MR Arthrography and Arthroscopy Findings]. / MR vysetrení skafolunátního vazu ve vysokém rozlisení s pouzitím mikroskopické cívky: srovnání s prímou MR artrografií a artroskopickými nálezy.

PURPOSE OF THE STUDY Scapholunate dissociation is a clinically most frequently diagnosed form of carpal instability. The aim of this study was to compare high resolution MRI using a microscopic coil with direct MRI arthrography in patients with suspected scapholunate ligament lesions and compare the results with arthroscopy findings and Geissler's arthroscopy classification. MATERIAL AND METHODS A prospective study was carried out in 47 patients (average age, 30.7 years) with clinical symptoms of wrist instability from 2013 to 2014. The patients were examined with the MR device Philips Achieva 1.5T using a microscopic coil and subsequently by direct MR arthrography. The results of examination were evaluated independently by two groups of physicians using a modified arthroscopic classification. The results were verified arthroscopically. For evaluation, an adjusted Geissler's classification was used. The study was approved by the Multicentre Ethics Committee of the Faculty of Medicine in Brno and informed consent was obtained from each patient. RESULTS A total of The MRI examination was evaluated and included in the study in 44 patients (three were excluded for the presence of motion artefacts). Only 20 patients underwent arthroscopy. Examination with a microscopic coil correctly classified 14 of them; an accuracy of 70 % (95 % CI: 45.7 % - 88.1 %) and p = 0.021. Direct MR arthrography correctly classified 16 of 20 injured ligaments, i.e., an accuracy of 80 % (95 % CI: 56.3 % - 94.3 %) and p = 0.002. DISCUSSION Currently, the diagnosis of pathological changes in the wrist is made by routine MRI especially when there is the possibility of using sequences with high spatial resolution. Even though we achieved poorer results by native examination using these techniques, when they were compared with the results of direct MR arthrography, they were still better than those reported in the recent literature. CONCLUSION The optimal method for an examination algorithm of scapholunate ligament lesions is direct MR arthrography. In our study correct findings of direct MR arthrography using Geissler's classification were shown in 80 % of the patients. Key words: scapholunate ligament, scapholunate ligament lesion, direct MR arthrography, microscopic coil, Geissler's classification.

[The use of hybrid revascularization procedures for the therapy of multilevel lower extremity arterial disease--analysis of single center experience]. / Analýza výsledku hybridních revaskularizacních výkonu pro multietázové postizení tepenného systému dolních koncetin--výsledky jednoho centra.

INTRODUCTION: The goal of this study was to evaluate our experience and results of single staged hybrid procedures for revascularization of lower extremities affected by multilevel arterial occlusive disease. We analysed the effect of the indication and type of reconstruction on patency. METHOD: Patients were retrospectively reviewed. Data collection was conducted prospectively. Patients were divided into 5 groups based on the type of hybrid reconstruction. Group "1" included patients who underwent transluminal angioplasty (TA)±stenting of iliac arteries with endarterectomy (EA) and patch arterioplasty of the femoral bifurcation (35 patients; 27.6 %). Group "2" included patients who underwent TA±stenting of iliac arteries with infrainguinal bypass (15 patients; 11.8 %). Group "3" consisted of patients who underwent TA±stenting of outflow lower extremity arteries: superficial femoral artery±popliteal artery±crural arteries in combination with EA and patch arterioplasty of the femoral bifurcation (52 patients; 40.9 %). Group "4" represented patients who underwent infrainguinal bypass surgery in combination with TA distal to the site of open reconstruction (3 patients; 2.4%). Group "5" represented a heterogenous population of patients who underwent a hybrid reconstruction which did not belong to any of the 4 previously mentioned groups (22 patients; 17.3 %). The patients were divided into 3 groups based on the indication criteria of the intervention: Patients with acute limb ischemia (ALI) were put into group "ALI". Patients with critical limb ischemia (CLI) were put into group "CLI". Patients with claudications were put into group "II". Patency analyses were performed using Kaplan-Meier life tables. Differences in patency rates between the different groups of patients were determined using the log-rank test. Statistical analysis was performed using the software IBM SPSS Statistics 21.0. RESULTS: The study included 127 patients who underwent 127 hybrid arterial procedures. Technical and clinical success rates were 96.9% and 98.4%. 30-day perioperative mortality rate was 3.1%. The primary (PP), assisted-primary (APP) and secondary patency (SP) results at 2 years were the best amongst the patients from groups "1" and "3". These patients underwent patch arterioplasty±EA of the femoral bifurcation in combination with transluminal angioplasty of inflow or outflow arteries of the lower extremity. The resulting PP, APP and SP rates at 2 years in group "1" were 80.6%, 84.3% and 84.3%. Patency rates in group "3" in the same order at 2 years were 81.1 %, 82.8% and 86.3%. Significantly lower patency rates were achieved in patients from groups "2" and "5". The resulting PP, APP and SP rates in group "2" at 2 years were 39.4%, 59.1% and 59.1%; in group "5" at 2 years they were 30.4%, 49.2% and 70.7%. Taking into account the effect of the indication on patency rates, we found that patients from group "CLI" had the best APP and SP rates at 2 years: 81.6% and 86.2%. Only the PP rate at 2 years was the best in group "II" (patients with claudications): 71.1%. Patients who underwent their operations because of acute limb ischemia (group "ALI") achieved the worst results among these 3 groups. Their PP, APP and SP rates at 2 years were 33.7%, 46.2% and 45.5%. Patients from the group "CLI" had the best amputation-free survival at 2 years: 89.1% amongst the 3 groups subdivided according to the indication for the intervention ("II" 81.9%; "ALI" 61.4%). Overall survival and amputation-free survival at 2 years were 93.2% and 82.3%, respectively, for the whole studied population. CONCLUSION: The hybrid procedure is an intervention which combines endovascular and open reconstruction performed at the same time. Hybrid procedures provide effective therapy for patients with multilevel lower extremity arterial disease. They have low complication rates, periprocedural morbidity and mortality. Using these procedures, we are able to achieve good limb salvage rates and patency rates irrespective of the form of chronic limb ischemia (claudications, critical limb ischemia). Results for patients with acute limb ischemia are inferior. The combination of patch arterioplasty±endarterectomy of the femoral bifurcation with transluminal angioplasty of inflow or outflow limb arteries is our hybrid procedure of choice with the most favourable results.

Sensitivity of PPI analysis to differences in noise reduction strategies.

BACKGROUND: In some fields of fMRI data analysis, using correct methods for dealing with noise is crucial for achieving meaningful results. This paper provides a quantitative assessment of the effects of different preprocessing and noise filtering strategies on psychophysiological interactions (PPI) methods for analyzing fMRI data where noise management has not yet been established. METHODS: Both real and simulated fMRI data were used to assess these effects. Four regions of interest (ROIs) were chosen for the PPI analysis on the basis of their engagement during two tasks. PPI analysis was performed for 32 different preprocessing and analysis settings, which included data filtering with RETROICOR or no such filtering; different filtering of the ROI "seed" signal with a nuisance data-driven time series; and the involvement of these data-driven time series in the subsequent PPI GLM analysis. The extent of the statistically significant results was quantified at the group level using simple descriptive statistics. Simulated data were generated to assess statistical improvement of different filtering strategies. RESULTS: We observed that different approaches for dealing with noise in PPI analysis yield differing results in real data. In simulated data, we found RETROICOR, seed signal filtering and the addition of data-driven covariates to the PPI design matrix significantly improves results. CONCLUSIONS: We recommend the use of RETROICOR, and data-driven filtering of the whole data, or alternatively, seed signal filtering with data-driven signals and the addition of data-driven covariates to the PPI design matrix.

Late divergence of target and nontarget ERPs in a visual oddball task.

Different mental operations were expected in the late phase of intracerebral ERPs obtained in the visual oddball task with mental counting. Therefore we searched for late divergences of target and nontarget ERPs followed by components exceeding the temporal window of the P300 wave. Electrical activity from 152 brain regions of 14 epileptic patients was recorded by means of depth electrodes. Average target and nontarget records from 1800 ms long EEG periods free of epileptic activity were compared. Late divergence preceded by almost identical course of the target and nontarget ERPs was found in 16 brain regions of 6 patients. The mean latency of the divergence point was 570+/-93 ms after the stimulus onset. The target post-divergence section of the ERP differed from the nontarget one by opposite polarity, different latency of the components, or even different number of the components. Generators of post-divergence ERP components were found in the parahippocampal gyrus, superior, middle and inferior temporal gyri, amygdala, and fronto-orbital cortex. Finding of late divergence indicates that functional differences exist even not sooner than during the final phase of the task.

Sequestration of MBNL1 in tissues of patients with myotonic dystrophy type 2.

The pathogenesis of myotonic dystrophy type 2 includes the sequestration of MBNL proteins by expanded CCUG transcripts, which leads to an abnormal splicing of their target pre-mRNAs. We have found CCUG(exp) RNA transcripts of the ZNF9 gene associated with the formation of ribonuclear foci in human skeletal muscle and some non-muscle tissues present in muscle biopsies and skin excisions from myotonic dystrophy type 2 patients. Using RNA-FISH and immunofluorescence-FISH methods in combination with a high-resolution confocal microscopy, we demonstrate a different frequency of nuclei containing the CCUG(exp) foci, a different expression pattern of MBNL1 protein and a different sequestration of MBNL1 by CCUG(exp) repeats in skeletal muscle, vascular smooth muscle and endothelia, Schwann cells, adipocytes, and ectodermal derivatives. The level of CCUG(exp) transcription in epidermal and hair sheath cells is lower compared with that in other tissues examined. We suppose that non-muscle tissues of myotonic dystrophy type 2 patients might be affected by a similar molecular mechanism as the skeletal muscle, as suggested by our observation of an aberrant insulin receptor splicing in myotonic dystrophy type 2 adipocytes.

[Efficacy of combination treatment with pegylated interferon plus ribavirin in patients chronically infected with HCV]. / Ucinnost terapie pegylovaným interferonem a ribavirinem u pacientu s chronickou HCV infekcí.

THE AIM OF THE STUDY: To evaluate the efficacy of combined antiviral treatment with pegylated interferon alpha plus ribavirin in patients with chronic HCV infection who have not yet been treated with antivirals (treatment-naive patients). To compare the treatment effect in patients with low (< 600,000 IU/ml) and high (> or = 600,000 IU/ml) initial viremia. METHODS AND TREATMENT REGIME: Treatment-naive patients with chronic HCV infection treated with the combination therapy of pegylated interferon-alpha2a plus ribavirin. Treatment response was evaluated at weeks 12, 24 and 48 when treatment was ongoing and at weeks 12, 24 and 48 after the treatment was finished. Commercially available sets from various manufacturers were used for serum and molecular genetic diagnostics of HCV infection. PATIENT SAMPLE: Antiviral treatment was initiated in 175 patients between 2001 and 2007. The complete data sets suitable for statistical analysis were available for 143 patients. End of treatment response and sustained viral response analyses were conducted separately for HCV genotype 1 (n = 124) and genotype 2 + 3 (n = 7). RESULTS: In the genotype 1 group, 76% of patients achieved end of treatment response and 59% of patients achieved sustained viral response. Both types of response were observed in 100% of the genotype 2 and 3 infected patients. When a correlation between initial viremia and sustained viral response was analysed, no statistically significant difference was observed between patients with low (< 600,000 IU/ml) and high (> or = 600,000 IU/ml) initial viremia. CONCLUSION: The results observed in the present study are generally slightly better than comparable results from large registration studies. In contrary to the published literature, the threshold of 600,000 IU/ml for initial viremia did not correlate statistically significantly with SVR.