Rectal cancer - current treatment strategy and the tumor regression grade evaluation after neoadjuvant therapy in patients who underwent surgery at the I. Department of Surgery, General University Hospital in Prague between 2012 and 2016.

INTRODUCTION: The article contains a summary of the issues of staging and therapy with an emphasis on the neoadjuvant treatment and associated tumor regression grade with the analysis of our own group of patients. METHODS: Retrospective analysis of patients with rectal cancer who underwent a surgery at the 1st Department of Surgery - Thoratic, Abdominal and Injury Surgery; First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic, focusing on those who underwent neoadjuvant chemoradiotherapy and their pathologists evaluated tumor regression grade after the resection. RESULTS: The group consists of 161 patients operated on between 2012 and 2016. 47 patients underwent neoadjuvant oncological treatment with further evaluation of the tumor regression grade by a pathologist, a scoring system according to Ryan was used. A complete pathological response was elicited in 10.4% of patients, no response in 35.4% of patients, and partial tumor regression in 54.2%. CONCLUSION: Although there is a difference in our results compared to foreign publications, the proportion of patients remains comparable. Studies evaluating the advantages versus disadvantages of neoadjuvant therapy will certainly follow, and the question of the suitability of surgical treatment as the only curative solution is partially raised.

Intra-abdominal candidiasis in surgical intensive care unit - epidemiology characteristics and trends.

OBJECTIVES: Intra-abdominal candidiasis (IAC) is an invasive fungal infection representing the most common type of invasive Candida infection in surgical intensive care units (ICUs). Recently, decreased antifungal susceptibility and progressive shift in the aetiology of invasive candidiasis has been observed worldwide. We explored IAC epidemiology in surgical ICU. MATERIAL AND METHODS: We retrospectively reviewed the records of 64 patients with IAC admitted at our surgical ICU over a 4-year period (2013-2016). IAC incidence, microbiological results, antifungal therapy, and mortality were analysed. RESULTS: The cumulative IAC incidence was 18.4 cases per 1000 admissions (2013: 12.6; 2014: 17.7; 2015: 16.8; 2016: 24.5), including hospital-acquired IAC incidence (2013: 9.8; 2014: 13.3; 2015 10.1; 2016: 13.3) and community-acquired IAC incidence (2013: 2.8; 2014: 4.4; 2015: 6.7; 2016: 11.2). Candida albicans represented the most common species (n = 35, 50.0%) followed by Candida glabrata (n = 15, 21.4%), Candida tropicalis (n = 6, 8.6%) and other yeasts (each < 5.0%). Incidence rate of C. albicans (2013: 7(78%); 2014: 10(59%); 2015: 6(35%); 2016: 12(44%)) and incidence rate of C. non-albicans (2013: 2(22%); 2014: 7(41%); 2015: 9(53%); 2016: 14(52%)) were different in trend. All fungal isolates were susceptible to echinocandins, amphotericin B and voriconazole. Regarding fluconazole susceptibility, C. krusei (n = 3) was resistant and C. glabrata (n = 9) was susceptible-dose dependent (SDD). The ratio of SDD C. glabrata isolates to all isolated C. glabrata strains was 9/15 (60%) (2013: 0/2; 2014: 0/2; 2015: 1/3; 2016: 8/8). Decreased fluconazole susceptibility for C. glabrata isolates was reported in both community-acquired IAC (n = 3) and hospital-acquired IAC (n = 6). Overall 30-day mortality rate was 25.0% (16/64). CONCLUSIONS: We have revealed slowly raising of overall IAC incidence, more increasing trend in incidence of community-acquired IAC compared to rather steady incidence of hospital-acquired IAC. During period 2013-2016 we have observed a significant shift in the aetiology of IAC towards an increased proportion of non-albicans Candida species, particularly C. glabrata. Acquired decreased fluconazole susceptibility was related to C. glabrata isolates exclusively. Emergence of decreased antifungal susceptibility has been preceded by increase of non-albicans Candida isolates.

Novel spectroscopic biomarkers are applicable in non-invasive early detection and staging classification of colorectal cancer.

Colorectal cancer (CRC) remains a significant threat to human health because of the lack of awareness of physical examination or the limitations of an early diagnostic level. Despite the improving standard of modern medicine, mortality from CRC is still remarkably high and the prognosis remains poor in many cases because of disease detection at advanced clinical stages. Raman spectroscopy yields precise information, not only regarding the secondary structure of proteins but also regarding the discrimination between normal and malignant tissues. We investigated whether this method can be used for the diagnosis of CRC including initial stages. To acquire more detailed structural information, we tested a novel diagnostic approach based on a suitable combination of conventional methods of molecular spectroscopy (Raman and Fourier transform infrared) with advanced, highly structure-sensitive chiroptical techniques as electronic circular dichroism (ECD) and Raman optical activity (ROA) to monitor the CRC pathogenesis relating compositional, structural and conformational changes in blood biomolecules, some of which may be caused by pathological processes occurring during cancer growth, also at the beginning of the disease. Sixty-three blood plasma samples were analyzed using the combination of ECD and ROA supplemented by Raman and Fourier transform infrared (FT-IR) spectroscopies. The obtained spectra were evaluated together by linear discriminant analysis. The accuracy of sample discrimination reached 100% and the subsequent leave-one-out cross-validation resulted in 90% sensitivity and 75% specificity. There were also found the differences between the patients according to the clinical stage. The achieved results suggest a panel of promising biomarkers and indicate that chiroptical methods combined with conventional spectroscopies might be a new minimally invasive powerful tool for producing high-quality data, obtaining an accurate diagnosis of colorectal cancer through a peripheral blood sample, which is also able to determine the extent of this pathology. Further work needs to be carried out for these techniques to be implemented in the clinical setting.

[Prolonged prophylaxis of thromboembolic disease in patients with colorectal surgical resections for malignancy]. / Prodlouzená profylaxe tromboembolické nemoci u pacientu po chirurgické resekci kolorekta pro malignitu.

UNLABELLED: Cancer patients have 6-fold higher risk of venous thromboembolism compared with patients without malignancy. This risk of VTE is further increased by cancer surgery. AIM OF THE STUDY: The aim of our pilot study was to examine the changes in inflammatory reaction, changes of coagulation parameters and inhibition of FXa in patients with new diagnosed colorectal cancer. During 30 days of observation prophylactic dose of dalteparin 5000 UI subcutaneously once daily was administrated. PATIENTS AND METHODS: Patients who underwent surgical resection of the colon for new diagnosed colorectal cancer were included in the study. Laboratory tests (blood count, acute phase proteins--alpfa-1-antitrypsin, transferin, prealbumin, alpfa-2-makroglobulin, orosomukoid and C reactive protein and coagulation laboratory tests--PT in INR, aPTT, TT, fibrinogen concentration, activity of antithrombinu and concentration of D-dimer) were performed before surgery and on day 3, 10 and 30 after surgery. RESULTS: Inflammatory response reached highest level on day 3, lasted until day 10 after surgery than parameters returned to normal values (p < 0.05). Hypercoagulable tendency was already seen before surgery, highest value of D-dimer was measured on day 10 after surgery and after decrease it lasted until the day 30 after surgery (p < 0.05). Inhibition of FXa varied between 0.02-0.7 IU/ml. The prophylactic range of FXa inhibition 0.2-0.4 IU/ml was reached in 48.1% of the samples, 20.4% of the samples were over the range and 31.5% were under the prophylactic range. During 30 day of observation deep vein thrombosis was not detected in any patient as well as bleeding complication. CONCLUSION: The pilot study shows that prolonged prophylaxis of VTE is advisable in patients after cancer surgery. Variation of FXa inhibition will be in our study further examined.