[Effects of Tranexamic Acid on Perioperative Blood Loss and Wound Hematoma Development in Lumbar Spine Surgery: a Prospective Randomized Study]. / Vliv tranexamové kyseliny na perioperacní krevní ztrátu a rozvoj hematomu v ráne u operací bederní pátere: prospektivní randomizovaná studie.

PURPOSE OF THE STUDY Tranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss reduction in specific surgical procedures. The aim of our study was to evaluate the effect of tranexamic acid on reducing intraoperative blood loss, postoperative blood loss into the drain, total blood loss, transfusion requirements, and development of symptomatic wound hematoma in conventional single-level lumbar decompression and stabilization. MATERIAL AND METHODS The study included patients who had undergone a traditional open lumbar spine surgery in the form of single-level decompression and stabilisation. The patients were randomized into two groups. The study group received a 15 mg/kg dose of tranexamic acid intravenously during the induction of anaesthesia and then again 6 hours later. No tranexamic acid was administered to the control group. In all patients, intraoperative blood loss, postoperative blood loss into the drain, and therefore also total blood loss, transfusion requirements and potential development of a symptomatic postoperative wound hematoma requiring surgical evacuation were recorded. The data of the two groups were compared. RESULTS The cohort includes 162 patients, 81 in the study group and the same number in the control group. In the intraoperative blood loss assessment, no statistically significant difference between the two groups was observed; 430 (190-910) mL vs. 435 (200-900) mL. In case of post-operative drain blood loss, a statistically significantly lower volume was reported after the tranexamic acid administration; 405 (180-750) mL vs. 490 (210-820) mL. When evaluating the total blood loss, a statistically significant difference was also confirmed, namely in favour of the tranexamic acid; 860 (470-1410) mL vs. 910 (500- 1420) mL. The reduction of total blood loss did not result in a difference in the number of administered transfusions; transfusions were given to 4 patients in each group. A postoperative wound hematoma requiring surgical evacuation developed in 1 patient in the group with the tranexamic acid and in 4 patients in the control group, but the difference was not statistically significant with respect to the insufficient group size. No patient in our study experienced complications associated with tranexamic acid application. DISCUSSION The beneficial effect of tranexamic acid on reducing blood loss in lumbar spine surgeries has already been confirmed by numerous meta-analyses. The question remains in what types of procedures, at what dose and route of administration its effect is significant. To date, most of the studies have explored its effect in multi-level decompressions and stabilizations. Raksakietisak et al., for instance, report significant reduction in total blood loss from 900 (160, 4150) mL to 600 (200, 4750) mL following an intravenous injection of 2 bolus doses of 15 mg/kg tranexamic acid. In less extensive spinal surgeries, the effect of tranexamic acid may not be that distinct. In our study of single-level decompressions and stabilizations, no reduction in the actual intraoperative bleeding was confirmed at the given dosage. Its effect was seen only in the postoperative period in a significant reduction of blood loss into the drain, thus also in the total blood loss, although the difference between 910 (500, 1420) mL and 860 (470, 1410) mL was not that significant. CONCLUSIONS By intravenous application of tranexamic acid in 2 bolus doses in single-level decompression and stabilization of the lumbar spine a statistically significant reduction in postoperative blood loss into the drain and also total blood loss was confirmed. The reduction in the actual intraoperative blood loss was not statistically significant. No difference was observed in the number of administered transfusions. Following the tranexamic acid administration, a lower number of postoperative symptomatic wound hematomas was recorded, but the difference was not statistically significant. Key words: tranexamic acid, spinal surgeries, blood loss, postoperative hematoma.

Unusual foreign body in the nasal cavity after craniofacial injury.

A 68-year-old man with severe craniofacial trauma underwent endoscopic surgery for nasal cerebrospinal fluid leak. During the operation, a plastic object in the shape of a spectacle lens was found wedged in the left nasal passage, which we extracted. As subsequently established from the patient's documentation, it was a dislodged acrylic implant originally placed at the base of the orbit which was surgically treated after an injury to the facial skeleton thirty-five years ago. What is also rare about this is the fact that the patient had been examined for many years at the otorhinology department for purulent discharge from the left nasal cavity and impaired ventilation. The patient had also undergone an endoscopic examination of the nasal cavity during which an intranasal tumor was even suspected, but it was not histologically confirmed.

[Coccygodynia: Case Reports and Literature]. / Coccygodynie: vlastní kazuistiky a prehled literatury.

Coccygodynia, or tailbone pain, is the most common in women after trauma (complicated childbirth, fall). This pain can be treated conservatively (by using analgesics, local injections, physiotherapy) or by surgical coccygectomy. In the presented article, a set of five female patients is evaluated, in whom, after the failing conservative therapy, coccygectomy was indicated for persistent coccygodynia. In all female patients, improvement of their clinical condition and alleviation of pain were reported. Coccygectomy has its place in the management of coccygodynia and in correctly chosen patients significant pain reduction can be expected. Key words: coccygodynia, coccyx, coccygectomy, trauma.

The EBSD spatial resolution of a Timepix-based detector in a tilt-free geometry.

Performing EBSD with a horizontal sample and a parallel EBSD detector sensor, enables safer specimen movements for data collection of large specimen areas and improves the longitudinal spatial resolution. The collection of electron backscattering patterns (EBSPs) at normal incidence to the electron beam has been revisited via the use of a direct electron detection (DED) sensor. In this article we present a fully operational DED EBSD detection system in this geometry, referred to as the tilt-free geometry. A well-defined Σ=3[101]{121} twin boundary in a Molybdenum bicrystal was used to measure the physical spatial resolution of the EBSD detector in this tilt-free geometry. In this study, two separate methods for estimating the spatial resolution of EBSD, one based on a pattern quality metric and the other on a normalised cross correlation coefficient were used. The spatial resolution was determined at accelerating voltages of 8 kV, 10 kV, 12 kV, 15 kV and 20 kV ranging from ~22-38 nm using the pattern quality method and ~31-46 nm using the normalised cross correlation method.

[Minimally Invasive Sacroiliac Joint Stabilization]. / Minimálne invazivní stabilizace sakroiliackého skloubení.

PURPOSE OF THE STUDY Sacroiliac joint dysfunction is defined as a permanent chronic pain originating from the sacroiliac joint, limiting the patient's daily activities. The purpose of this study was to evaluate the effectiveness of the minimally invasive sacroiliac joint stabilization by triangular titanium implants in patients with sacroiliac joint dysfunction. MATERIAL AND METHODS The prospective study evaluated the patients who had underwent a minimally invasive sacroiliac joint stabilization for sacroiliac joint dysfunction with the use of iFuse® implants. The surgery was performed solely under fluoroscopic guidance or together with the use of O-arm O2® mobile imaging system. The clinical condition, the Visual Analogue Scale preoperatively and one year postoperatively, previous surgeries in the lumbar spine region, the use of O-arm and occurrence of complications were recorded. The minimum follow-up period was 1 year. RESULTS The group was composed of 20 patients, of whom 4 men and 16 women. The mean age was 48.9 years. The surgeries covered 21 sacroiliac joints. Improvement of the clinical condition was reported in 17 cases (81.0%), no relief was observed in 4 cases (19%). The mean VAS score was 6.1 points preoperatively and decreased to 2.9 points postoperatively (p=0.0001). CONCLUSIONS The minimally invasive sacroiliac joint stabilization should be reserved for patients experiencing an intractable pain originating from the sacroiliac joint, in whom all non-operative therapy failed. Key words: minimally invasive sacroiliac joint stabilization, sacroiliac joint dysfunction, O-arm.

[Autologous cranioplasty with a bone flap preserved subcutaneously in the mesogastrium]. / Autologní kranioplastika deponovanou kostní ploténkou v podkozí mezogastria.

INTRODUCTION: Cranioplasty with autologous bone flap is indicated in patients who have undergone decompressive craniectomy. Although it is an elective procedure, literature data indicate complication rates of up to 30%. The aim of this paper is to present our experience with cranioplasty with the patients own bone flap stored subcutaneously in the mesogastrium. METHODS: We retrospectively analyzed a set of 92 patients who had undergone cranioplasty after decompressive craniectomy using autologous graft preserved subcutaneously in the mesogastrium. The patients were clinically and radiologically examined before the surgery, and six weeks and one year after surgery. We evaluated the incidence of acute complications - wound hematoma, and late complications - infection and bone resorption. The postoperative cosmetic effect and patient discomfort from the stored bone flap also constituted an important aspect. RESULTS: The frequency of complications in our study group was 25%. Late complications were the most common, occurring with a frequency of 13%. These were mainly resorption of the bone flap (4.3%) and infectious complications (4.3%). Acute complications occurred with a frequency of 10.9% in our patient group. The most serious complication was cerebral edema of unknown origin leading to death of the patient. Unsatisfactory cosmetic effect as well as discomfort at the site where the flap was stored occurred in two cases. CONCLUSIONS: Cranioplasty is associated with a higher risk of complications in comparison with other elective procedures. Nevertheless, we regard cranioplasty with subcutaneously preserved bone flap as an inexpensive and suitable alternative to cryopreservation or alloplastic materials.Key words: cranioplasty complications of cranioplasty autologous cranioplasty decompressive craniectomy.

Change in performance in response to training load adjustment based on autonomic activity.

The primary aim of this study was to assess performance (Perf) changes in response to a new training strategy. Specifically, based on spectral analysis of heart rate variability (SA HRV) to determine autonomic nervous system (ANS) activity, training doses were adjusted to maintain vagal activity at a high and relatively stable level during training preparation. Trained athletes (5 male and 5 female) aged 23.2±4.2 years voluntarily participated in the study. ANS activity was assessed during an orthoclinostatic test, and was represented by calculating HRV variables and a total score index. Over 17 weeks, improvement (1.4-8.5%) and deterioration (0.1-8.8%) in Perf were detected in 7 and 3 athletes, respectively. A relationship (rs=0.684; P<0.05) between the change in Perf (ΔPerf) and supine PHF during season was found. Supine HRV indices (PHF, PT, and MSSD) for the last 3 weeks of the HRV-adjusting period correlated (rs=0.636; 0.648; 0.648, P<0.05) with ΔPerf. Based on the results, a high and relative stable vagal activity during preparation may indicate a readiness to train or appropriate recovery that positively affects Perf. In conclusion, daily quantification of ANS activity by SA HRV seems to be a promising tool for the enhancement of Perf.

Vagal threshold determination. Effect of age and gender.

Progressive increases in exercise intensity cause significant decreases in vagal activity (VA) until a critical point called the vagal threshold (TVA) is reached. This is where further increases in exercise intensity cause negligible change in VA. This study was designed to develop the algorithm for the TVA determination and to assess the effects of age and gender on its level. The sample consisted of 40 subjects who were divided according to age and gender into 4 groups with 10 subjects each: G1-Men age 25-31, G2-Men age 40-57, G3-Women age 24-28, and G4-Women age 43-56. The vagal responses were assessed by spectral analysis of the heart rate variability method while walking on a treadmill in a steady-state at intensities of 20-70% of the maximal heart rate reserve (MHRR). The mean intensity of 45% MHRR was suggested as the TVA level which is related neither to age nor gender. Heart rate related to TVA (TVA-HR) was affected by gender. High frequency power at TVA was influenced by age. The TVA-HR was considered to be a promising tool for the prescription of a safe level of physical activity for subjects with higher risks of health complications involving elevated sympathoadrenal activity during exercise.

Fibroblast growth factor-19: development, analytical characterization and clinical evaluation of a new ELISA test.

OBJECTIVE: Since fibroblast growth factor 19 (FGF-19) is a potent metabolic regulator that influences glucose and lipid homeostasis, our aim was to develop an ELISA assay for measuring FGF-19 in human serum and to investigate its concentrations in healthy volunteers and patients suffering from metabolic syndrome. MATERIAL AND METHODS: A sandwich ELISA method was developed for quantitative determination of human FGF-19 in serum samples. Blood pressure, waist circumference, FGF-21 serum levels, serum cholesterol, triacylglycerols, HDL-cholesterol, LDL-cholesterol, insulin, glucose, adiponectin, uric acid, creatinine, hs-CRP and calculated BMI and Quicki insulin sensitivity index were measured in 153 healthy volunteers and 66 persons with metabolic syndrome. RESULTS: Neither sex nor age influenced FGF-19 serum concentration in the healthy volunteers. Probands with metabolic syndrome had 65 % lower FGF-19 serum values than the healthy ones (medians 158.6 versus 242.4 ng/L; p<0.01). FGF-19 correlated with glucose (r = -0.35, p<0.01), HDL (r = 0.24, p = 0.045), triacylglycerols (r = -0.19, p = 0.05) and with a number of other risk factors for metabolic syndrome (r = -0.28, p = 0.01). When adjusted to the concentrations of triacylglycerols, BMI and glucose, and finally to all data pertinent to FGF-19 (according to correlation analysis), our data indicate that FGF-19 is an independent marker of metabolic syndrome. CONCLUSIONS: The present study demonstrates the analytical properties of the ELISA FGF-19 assay and its usefulness when studying the metabolic syndrome. Serum concentrations of FGF-19 could be new key predictors of metabolic syndrome and thereby even a new negative risk factor of atherosclerosis.

Lipocalin-2: development, analytical characterization, and clinical testing of a new ELISA.

Lipocalin-2 (also known as neutrophil gelatinase-associated lipocalin [NGAL]) has been described as a promising marker of metabolic syndrome associated with inflammation. The aim of our work was to develop an assay for the determination of lipocalin-2 in human serum and to investigate its levels in healthy volunteers and donors suffering from metabolic syndrome. We also conducted a pilot study on individuals with metabolic syndrome and on healthy probands and measured lipocalin-2 in these individuals. We developed and evaluated the sandwich ELISA method for the quantitative determination of human lipocalin-2 in serum samples. We measured blood pressure, waist circumference, serum cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, insulin, glucose, creatinine, hs-CRP, and adiponectin and calculated the BMI and Quicki insulin sensitivity index. In the study on 153 healthy volunteers, we showed that sex and age are not determinative for lipocalin-2 serum values. Furthermore, we tested 45 individuals with metabolic syndrome; values of lipocalin-2 did not differ (78.8 vs. 80.0 microg/l, p =0.56) from the data of healthy individuals from the first study. Neither group differed with regard to sex or age. Lipocalin-2 correlated with alanine aminotransferase (ALT) (r=-0.3, p<0.01) aspartate aminotransferase (AST) (r=-0.3, p<0.01), cholesterol (r=-0.21, p=0.047), creatinine (r=0.19, p=0.05), and high-sensitivity C-reactive protein (hs-CRP) (r=0.22, p=0.036). No significant correlation was found between serum lipocalin-2 and BMI, waist circumference, blood pressure, triglycerides, HDL, Quicki, or the number of metabolic syndrome components. When study patients with metabolic syndrome were further stratified according to the number of components of metabolic syndrome, serum concentrations of lipocalin-2 did not differ. The results presented demonstrate the analytical competence of the lipocalin-2 assay. However, we assumed that lipocalin-2 is not a routinely usable marker of metabolic syndrome or obesity. The association between serum lipocalin-2 and obesity or metabolic syndrome was not validated in our study.

Angiopoietin-like protein 4: development, analytical characterization, and clinical testing of a new ELISA.

The aim of our work was to develop an assay for the determination of angiopoietin-like protein 4 (Angplt4) in human blood, and to investigate its levels in healthy volunteers and donors suffer from metabolic syndrome. We developed and evaluated the sandwich ELISA method for the quantitative determination of human Angplt4 in serum samples. We conducted also the pilot study on individuals with metabolic syndrome or familiar hypercholesterolemia and healthy probands and measured blood pressure, waist circumference, Angplt4 serum levels, serum cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, insulin, glucose, A-FABP and calculate BMI and QUICKI insulin sensitivity index. In the study on 30 healthy volunteers we demonstrated that sex or age is not the determinant for Angplt4 serum values. Furthermore, we tested 115 individuals with metabolic syndrome and found that probands with metabolic syndrome did not differ in Angplt4 values than healthy individuals from the first study (medians 8.7 vs. 8.1 ng/ml, p = 0.6). Individuals with metabolic syndrome did not differ in sex or age from healthy. Angplt4 values correlated with the HDL-cholesterol (r = -0.25; p < 0.01), FGF-21 (r = 0.23, p < 0.01), glucose (r = 0.17; p = 0.03), uric acid (r = 0.17; p = 0.49), lipocalin-2 (r = 0.23, p < 0.01), triacylglycerols (r = 0.25; p < 0.01) and number or characters of metabolic syndrome (r = 0.21; p < 0.01). No significant correlation was found between serum Angplt4 and BMI, WC or QUICKI. However, we performed stepwise regression and we found that Angplt4 was not an independent marker for metabolic syndrome. The patients from the metabolic syndrome group suffering diabetes mellitus (n = 83) did not differ in serum Angplt4 from the group of healthy patients, too. The pilot study supports the hypothesis about the role of Angplt4 as a new class of lipid metabolism modulator. Their values could be a new key predictors of metabolic syndrome. Further research is necessary to confirm our findings in individuals with dyslipidemia, obesity, coronary artery diseases and different medication in order to assess Angplt4 value as a risk predictor of accelerated atherosclerosis.

Determination of serum zinc-alpha-2-glycoprotein in patients with metabolic syndrome by a new ELISA.

OBJECTIVES: To develop an assay for the determination of ZAG in human serum, and to investigate its clinical relevance as a marker of metabolic syndrome. DESIGN AND METHODS: A new sandwich ELISA was introduced and clinically tested. RESULTS: ZAG serum level did not differentiate healthy subjects (27.4+/-8.3 mg/L; N=132) from patients with metabolic syndrome (24.9+/-8.1; N=92). ZAG correlated with glucose, creatinine and uric acid. CONCLUSION: The immunoassay offers a new research tool for glucose metabolism.

Angiopoietin-like protein 3: development, analytical characterization, and clinical testing of a new ELISA.

The aim of our work was to develop an assay for the determination of angiopoietin-like protein 3 (Angptl3) in human blood, and investigate its levels in healthy volunteers and donors suffer from metabolic syndrome and familiar hypercholesterolemia. We developed and evaluated the sandwich ELISA method for the quantitative determination of human Angptl3 in serum samples. We conducted also the pilot study on individuals with metabolic syndrome or familiar hypercholesterolemia and healthy probands. The following parameters were measured: blood pressure, waist circumference, Angptl3 serum levels, serum cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, insulin, glucose, A-FABP, and BMI and Quicki insulin sensitivity index was calculated. In the study on 93 healthy volunteers we demonstrated that sex or age is not the determinant for Angptl3 serum values. Futhermore, 118 individuals with metabolic syndrome and 200 patients with familiar hypercholesterolemia were tested and it was found that probands with metabolic syndrome or familiar hypercholesterolemia had higher Angptl3 values than healthy individuals from the first study (medians 289.5 vs. 277.1 vs. 224.8 ng/ml, p < 0.01). All of groups did not differ in sex or age. Angptl3 values correlated with the systolic blood pressure, LDL and A-FABP (p < 0.05). No connection of Angptl3 with triglycerides was found (presumably influences of statins, fibrates via PPARs, etc). However, we performed stepwise regression and found A-FABP and Angptl3 serum values as the independent markers for metabolic syndrome presence only (F ratio 29, p < 0.01). Then we adjusted Angptl3 to A-FABP (reputable metabolic syndrome marker) and recognised that Angptl3 is the A-FABP-independent marker. The pilot study supports the hypothesis about the role of Angptl3 as a new class of lipid metabolism modulator. Their values could be a new key predictors of metabolic syndrome. Further research is necessary to confirm our findings in individuals with dyslipidemia, obesity, CAD and different medication in order to assess Angptl3 value as a risk predictor of accelerated atherosclerosis.

Determination of leptin receptor in the serum and relations to laboratory and anthropological parameters in patients with atherosclerotic complications.

Leptin receptors are supposed to have signal effects and are located in most tissues in the organism but we failed to find literary data on concentration (measurement) of leptin receptors in the system circulation. We examined by the method of randomized selection the group of 20 patients with manifested atherosclerosis in whom BMI was calculated. Then we analyzed concentration of leptin receptor (double sandwich ELISA, standard recombinant human leptin), leptin, glucose, insulin, proinsulin, CRP and uric acid in the serum. The control group consisted of 103 probands without signs of atherosclerosis or other manifested diseases. The control group was subjected to determination of BMI, leptin and leptin receptor in the serum. Concentration of leptin receptor does not differ significantly between the patients with atherosclerosis and normal population. Probands with atherosclerosis showed a very close negative correlation between concentration of leptin receptor and leptinemia which is absent in normal population.

[Leptinaemia in the Czech population]. / Leptinémie v ceské populaci.

INTRODUCTION: Leptin is a protein, determined by the ob-gene which influences in a fundamental way the energy metabolism of the organism. A significant effect of leptin on the haematopoietic, immunological and endocrinological system cannot be ruled out nor its effect on the course of pregnancy and maturation of the organism. In humans leptinaemia correlates with the amount of subcutaneous fat which is due to a receptor or post-receptor disorder, obese subjects suffer frequently from hyperleptinaemia. OBJECTIVE: To assess the mean leptinaemia of the general population, seek relations between leptinaemia and anthropological indicators and age. METHODS: Using the method of random sampling the authors examined a group of 538 probands (252 males, 286 females) incl. 12% healthy students of the Faculty of Physical Culture in Olomouc, 37% subjects without acute or chronic complications feeling in good health and 37% patients of the metabolic and diabetological ambulance of the hospital in Sternberk. In each patient a detailed case-history was recorded, an anthropological examination was made and a venous blood sample was taken for leptin analysis (serum, ELISA-sandwich method of BIOVENDOR Co.) RESULTS: Spectrum of patients, whose condition and age distribution in our group corresponded to the general population of the Czech Republic. The mean age of the probands was 51 years (18 to 82 years), the examined group can be characterized as subjects lacking signs of obesity. Leptinaemia was on average about 10 ng/ml (minimum 0, maximum 97.9 ng/ml), whereby men had values round 6 and women round 14 ng/ml (women had also a greater adipose tissue mass). Non-obese subjects (BMI<26) had a mean leptinaemia of 5 (women cca 6, men cca 2 ng/ml), obese subjects (BMI>30) have a leptinaemia of cca 19 ng/ml (women about 26, men about 13 ng/ml). With advancing age the leptinaemia in adults rises up to the age of 70, in subjects above 70 years it does not change (in women it declines significantly). The dynamics of leptinaemia imitate the changes of BMI and percentage of adipose tissue (in men also a rise in WHR). Leptinaemia is associated with the BMI (correlation coefficient 0.55), with the percentage of body fat (correlation coefficient 0.75), and in men with the WHR (correlation coefficient 0.82). The association between ageand leptinaemia is only indicated (correlation coefficient 0.29) and is not very close. According to the authors results subcutaneous body fat is responsible for cca 60% of the variability of leptinaemia (in women as much as 74%), BMI for 23%, age and sex for cca 9% of the vriability of leptinaemia. In men the WHR is responsible for 66% of the variability of leptinaemia. With an increase of subcutaneous adipose tissue by 1% the leptinaemia increases by some 0.54 ng/ml (in men by 0.22 ng/ml, in women by 0.84 ng/ml), with increasing BMI leptinaemia rises by 0.44 ng/ml/u (in men by 1.3 ng/ml, in women by 1.72 ng/ml), with advancing age leptin rises by 0.24 ng/ml/year (in men by 0.16 ng/ml, in women by 0.28 ng/ml), changes of leptinaemia imitate changes of BMI and the percentage of body fat. With increasing WHR in men the leptinaemia rises by 2.6 ng/ml/0.1 WHR. CONCLUSION: Standards of leptinaemia for the general population of the Czech Republic were elaborated. Leptinaemia correlates most closely of all anthropometric indicators with subcutaneous fat and in men with the WHR index. With advancing age between 20 and 70 years leptunaemia rises and then decliunes insignificantly (in women the changes are however significant). The primary cause of the mentioned differencesare probably changes of the bodily constitution.