Publications by authors named "Vaclav Prochazka"

26 Publications

  • Page 1 of 1

Computed Tomography (CT)-Navigated Translumbar Hemodialysis Catheters: A 10-Year Single-Center Experience.

Med Sci Monit 2020 Dec 15;26:e927723. Epub 2020 Dec 15.

Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.

BACKGROUND In dialysis patients with exhausted usual central venous access sites, the translumbar hemodialysis catheter (TLC) provides a viable option for dialysis access. The technical success of catheter insertion, associated complications, and long-term patency of TLC were evaluated in this study. MATERIAL AND METHODS This retrospective study included 37 patients with occluded central thoracic veins in whom 39 TLC implantation procedures were performed and 196 patients with internal jugular vein hemodialysis catheters (JVC). TLC implantation was performed as a hybrid procedure with computed tomography (CT)-navigated translumbar inferior vena cava cannulation and subsequent fluoroscopy-guided hemodialysis catheter placement. RESULTS The rates of technical success of the implantations and minor periprocedural complications were 97.4% and 10.3% in the TLC group and 98.6% and 4.2% in the JVC group, respectively. The median follow-up in the TLC and JVC groups was 673 days and 310 days, respectively. The primary-assisted patency at the 1-year and 3-year follow-up was 88.7% and 72.0% in the TLC group and 81.6% and 67.0% in the JVC group, respectively, with no statistically significant difference between the 2 groups. The incidence rate of infection-related and patency-related complications calculated for 1000 catheter-days was 0.15 and 0.11 in the TLC group and 0.33 and 0.25 in the JVC group, respectively. CONCLUSIONS The CT-guided implantation of the TLC is a useful option to create dialysis access with a low complication rate and satisfactory long-term patency in patients without usual venous access.
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http://dx.doi.org/10.12659/MSM.927723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749525PMC
December 2020

Current Status of Cell-Based Therapy in Patients with Critical Limb Ischemia.

Int J Mol Sci 2020 Nov 26;21(23). Epub 2020 Nov 26.

Radiodiagnostic Institute, University Hospital Ostrava, 708 52 Ostrava, Czech Republic.

(1) Background: The treatment of peripheral arterial disease (PAD) is focused on improving perfusion and oxygenation in the affected limb. Standard revascularization methods include bypass surgery, endovascular interventional procedures, or hybrid revascularization. Cell-based therapy can be an alternative strategy for patients with no-option critical limb ischemia who are not eligible for endovascular or surgical procedures. (2) Aims: The aim of this narrative review was to provide an up-to-date critical overview of the knowledge and evidence-based medicine data on the position of cell therapy in the treatment of PAD. The current evidence on the cell-based therapy is summarized and future perspectives outlined, emphasizing the potential of exosomal cell-free approaches in patients with critical limb ischemia. (3) Methods: Cochrane and PubMed databases were searched for keywords "critical limb ischemia and cell therapy". In total, 589 papers were identified, 11 of which were reviews and 11 were meta-analyses. These were used as the primary source of information, using cross-referencing for identification of additional papers. (4) Results: Meta-analyses focusing on cell therapy in PAD treatment confirm significantly greater odds of limb salvage in the first year after the cell therapy administration. Reported odds ratio estimates of preventing amputation being mostly in the region 1.6-3, although with a prolonged observation period, it seems that the odds ratio can grow even further. The odds of wound healing were at least two times higher when compared with the standard conservative therapy. Secondary endpoints of the available meta-analyses are also included in this review. Improvement of perfusion and oxygenation parameters in the affected limb, pain regression, and claudication interval prolongation are discussed. (5) Conclusions: The available evidence-based medicine data show that this technique is safe, associated with minimum complications or adverse events, and effective.
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http://dx.doi.org/10.3390/ijms21238999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731417PMC
November 2020

Quantitative Morphology of Cerebral Thrombi Related to Intravital Contraction and Clinical Features of Ischemic Stroke.

Stroke 2020 12 12;51(12):3640-3650. Epub 2020 Oct 12.

Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (R.R.K., C.N., R.I.L., J.W.W.).

Background And Purpose: The purpose was to assess quantitatively and qualitatively the composition and structure of cerebral thrombi and correlate them with the signs of intravital clot contraction (retraction), as well as with etiology, severity, duration, and outcomes of acute ischemic stroke.

Methods: We quantified high-resolution scanning electron micrographs of 41 cerebral thrombi for their detailed cellular and noncellular composition and analyzed histological images for the overall structure with the emphasis on red blood cell compression, fibrin age, and the signs of inflammation.

Results: Cerebral thrombi were quite compact and had extremely low porosity. The prevailing cell type was polyhedral compressed erythrocytes (polyhedrocytes) in the core, and fibrin-platelet aggregates were concentrated at the periphery; both findings are indicative of intravital contraction of the thrombi. The content of polyhedrocytes directly correlated with the stroke severity. The prevalence of fibrin bundles was typical for more severe cases, while the content of fibrin sponge prevailed in cases with a more favorable course. The overall platelet content in cerebral thrombi was surprisingly small, while the higher content of platelet aggregates was a marker of stroke severity. Fibrillar types of fibrin prevailed in atherothrombogenic thrombi. Older fibrin prevailed in thrombi from the patients who received thrombolytics, and younger fibrin dominated in cardioembolic thrombi. Alternating layers of erythrocytes and fibrin mixed with platelets were common for thrombi from the patients with more favorable outcomes. Thrombi with a higher number of leukocytes were associated with fatal cases.

Conclusions: Most cerebral thrombi undergo intravital clot contraction (retraction) that may be of underestimated clinical importance. Despite the high variability of the composition and structure of cerebral thrombi, the content of certain types of blood cells and fibrin structures combined with the morphological signs of intravital contraction correlate with the clinical course and outcomes of acute ischemic stroke.
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http://dx.doi.org/10.1161/STROKEAHA.120.031559DOI Listing
December 2020

Nanocrystalline diamond-based impedance sensors for real-time monitoring of adipose tissue-derived stem cells.

Colloids Surf B Biointerfaces 2019 May 28;177:130-136. Epub 2019 Jan 28.

Institute of Physics, Czech Academy of Sciences v.v.i., Cukrovarnická 10, 162 00, Prague 6, Czech Republic; Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Prague, Czech Republic.

Cell-based impedance spectroscopy is a promising label-free method for electrical monitoring of cell activity. Here we present a diamond-based impedance sensor with built-in gold interdigitated electrodes (IDT) as a promising platform for simultaneous electrical and optical monitoring of adipose tissue-derived stem cells (ASCs). The impedance spectra were collected in a wide frequency range (from 100 Hz to 50 kHz) for 90 h of cell cultivation in chambers designed for static cultivation. Absolute impedance spectra were analyzed in terms of measured frequencies and cell properties monitored by a high-resolution digital camera. The control commercially-available impedance system, based on gold electrodes exposed to the cultivation media, and also our specially developed sensor with gold electrodes built into a diamond thin film detected three phases of cell growth, namely the phase of cell attachment and spreading, the phase of cell proliferation, and the stationary phase without significant changes in cell number. These results were confirmed by simultaneous live cell imaging. The design of the sensing electrode is discussed, pointing out its enhanced sensitivity for a certain case. The diamond-based sensor appeared to be more sensitive for detecting the cell-substrate interaction in the first phase of cell growth, while the control system was more sensitive in the second phase of cell growth.
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http://dx.doi.org/10.1016/j.colsurfb.2019.01.048DOI Listing
May 2019

Comparison of Mechanical Thrombectomy with Contact Aspiration, Stent Retriever, and Combined Procedures in Patients with Large-Vessel Occlusion in Acute Ischemic Stroke.

Med Sci Monit 2018 Dec 22;24:9342-9353. Epub 2018 Dec 22.

Department of Applied Mathematics, VŠB-Technical University of Ostrava, Ostrava, Czech Republic.

BACKGROUND We investigated the properties and effects of 5 mechanical thrombectomy procedures in patients with acute ischemic stroke. The relationships between the type of procedure, the time required, the success of recanalization, and the clinical outcome were analyzed. MATERIAL AND METHODS This prospective comparative analysis included 500 patients with acute ischemic stroke and large-vessel occlusion. We compared contact aspiration thrombectomy (ADAPT, n=100), stent retriever first line (SRFL, n=196), the Solumbra technique (n=64), mechanical thrombectomy plus stent implantation (n=81), and a combined procedure (n=59). RESULTS ADAPT provided shorter procedure (P<0.001) and recanalization times (P<0.001) than the other techniques. Better clinical outcome was achieved for ischemia in the anterior circulation than ischemia in the posterior fossa (P<0.001). Compared to the other techniques, patients treated with ADAPT procedure had increased odds of achieving better mTICI scores (P=0.002) and clinical outcome (NIHSS) after 7 days (P=0.003); patients treated with SRFL had increased odds of achieving better long-term clinical status (3M-mRS=0-2; P=0.040). Patients with SRFL and intravenous thrombolysis (IVT) had increased odds of better clinical status (3M-mRS=0-2; P=0.031) and decreased odds of death (P=0.005) compared to patients with SRFL without IVT. The other treatment approaches had no additional effect of IVT. Patients with SRFL with a mothership transfer had increased odds of achieving favorable clinical outcome (3M-mRS) compared to SRFL with the drip-and-ship transfer paradigm (P=0.015). CONCLUSIONS Our results showed that ADAPT and SRFL provided significantly better outcomes compared to the other examined techniques. A mothership transfer and IVT administration contributed to the success of the SRFL approach.
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http://dx.doi.org/10.12659/MSM.913458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320656PMC
December 2018

Serum C-peptide level correlates with the course of muscle tissue healing in the rabbit model of critical limb ischemia.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Jun 7;163(2):132-140. Epub 2018 Sep 7.

Radiodiagnostic Institute, University Hospital Ostrava, Czech Republic Corresponding author: Vaclav Prochazka, e-mail.

Aim: The therapeutic potential of adipose-derived stem cell conditioned medium (ASC-CM) was studied in the rabbit model of critical limb ischemia (CLI).

Methods: Rabbits received treatment with ASC-CM or placebo. Gastrocnemius muscle tissue was collected 35 days after ischemia induction. Ischemic changes were evaluated in hematoxylin-eosin stained tissues for early (necrotic lesions/granulation tissue) and late (fibrous scars) phases of tissue repair. The expression of proangiogenic miR-126 was also evaluated using in situ hybridization. The levels of cytokines, insulin, and C-peptide were measured in blood.

Results: Early repair phases were observed more often in placebo-treated samples (45.5%) than in ASC-CM-treated ones (22.2%). However, the difference was not statistically significant. We demonstrated a statistically significant positive correlation between the early healing phases in tissue samples and C-peptide levels in peripheral blood. The expression of proangiogenic miR-126 was also shown in a number of structures in all phases of ischemic tissue healing.

Conclusion: Based on our results, we believe that treatment with ASC-CM has the potential to accelerate the healing process in ischemic tissues in the rabbit model of CLI. The whole healing process was accompanied by miR-126 tissue expression. C-peptide could be used to monitor the course of the tissue healing process.
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http://dx.doi.org/10.5507/bp.2018.048DOI Listing
June 2019

The Role of von Willebrand Factor, ADAMTS13, and Cerebral Artery Thrombus Composition in Patient Outcome Following Mechanical Thrombectomy for Acute Ischemic Stroke.

Med Sci Monit 2018 Jun 11;24:3929-3945. Epub 2018 Jun 11.

Department of Cell and Developmental Biology, University of Pensylvania School of Medicine, Philadelphia, PA, USA.

BACKGROUND The aim of the study was to investigate the role of von Willebrand factor (vWF), the vWF-cleaving protease, ADAMTS13, the composition of thrombus, and patient outcome following mechanical cerebral artery thrombectomy in patients with acute ischemic stroke. MATERIAL AND METHODS A prospective cohort study included 131 patients with ischemic stroke (<6 hours) with or without intravenous thrombolysis. Interventional procedure parameters, hemocoagulation markers, vWF, ADAMTS13, and histological examination of the extracted thrombi were performed. The National Institutes of Health Stroke Scale (NIHSS) score was used on hospital admission, after 24 hours, at day 7; the three-month modified Rankin Scale score was used. RESULTS Mechanical thrombectomy resulted in a Treatment in Cerebral Ischemia (TICI) score of 2-3, with recanalization in 89% of patients. Intravenous thrombolysis was used in 101 (78%). Patients with and without intravenous thrombolysis therapy had a good clinical outcome (score 0-2) in 47% of cases (P=0.459) using the three-month modified Rankin Scale. Patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥15 had significantly increased vWF levels (P=0.003), and a significantly increased vWF: ADAMTS13 ratio (P=0.038) on hospital admission. Significant correlation coefficients were found for plasma vWF and thrombo-embolus vWF (r=0.32), platelet (r=0.24), and fibrin (r=0.26) levels. In the removed thrombus, vWF levels were significantly correlated with platelet count (r=0.53), CD31-positive cells (r=0.38), and fibrin (r=0.48). CONCLUSIONS In patients with acute ischemic stroke, mechanical cerebral artery thrombectomy resulted in a good clinical outcome in 47% of cases, with and without intravenous thrombolysis therapy.
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http://dx.doi.org/10.12659/MSM.908441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029516PMC
June 2018

Serum Cytokine and Growth Factor Levels in Children with Autism Spectrum Disorder.

Med Sci Monit 2018 Apr 29;24:2639-2646. Epub 2018 Apr 29.

Department of the Deputy Director for Science and Research, University Hospital Ostrava, Ostrava, Czech Republic.

BACKGROUND The immune system may have a role in the pathogenesis of autism spectrum disorder (ASD), including typical and atypical autism. The aim of this study was to determine whether a cytokine and growth factor panel could be identified for the diagnosis and prognosis in children with ASD, including typical and atypical autism. MATERIAL AND METHODS This study included 26 children with ASD (typical or atypical) and 11 of their siblings who did not have ASD. A panel of ten serum cytokines and growth factors were investigated using addressable laser bead assay (ALBIA) and enzyme-linked immunosorbent assay (ELISA) kits. Results were correlated with scores using the Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule (ADOS) for the children with ASD and compared with the findings from their siblings without ASD. RESULTS There were no statistically significant differences in serum cytokine and growth factor levels between children with ASD and their siblings. The scores using CARS and ADOS were significantly greater in children with typical autism compared with children with atypical autism as part of the ASD spectrum. Serum levels of cytokines and growth factors showed a positive correlation with CARS and ADOS scores but differed between children with typical and atypical autism and their siblings. CONCLUSIONS The findings of this study showed that serum measurement of appropriately selected panels of cytokines and growth factors might have a role in the diagnosis of ASD.
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http://dx.doi.org/10.12659/MSM.906817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946742PMC
April 2018

Liver regeneration during the associating liver partition and portal vein ligation for staged hepatectomy procedure in is positively modulated by stem cells.

Oncol Lett 2018 May 22;15(5):6309-6321. Epub 2018 Feb 22.

Department of Biology and Ecology, Faculty of Science, University of Ostrava, 71000 Ostrava, Czech Republic.

This present study investigated the impact of the application of stem cells to liver regeneration following the first stage of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The experiment was conducted on a pig model (n=6, 3 that did not receive application of stem cells, 3 that received application stem cells). Collected samples of liver (day 0 and 9 following surgery) were subjected to complete transcriptome sequencing. In total, 39 differentially expressed genes were found in the group without the application of the stem cells (genes of unwanted processes such as fibrosis and inflammation). In the group that did receive application of stem cells, no significantly differentially expressed genes were found, indicating a properly regenerated liver remnant. The present study therefore demonstrated, to the best of our knowledge for the first time, the positive effect of stem cells application in the liver regeneration process during ALPPS procedure in the pig model.
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http://dx.doi.org/10.3892/ol.2018.8108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876427PMC
May 2018

The Role of miR-126 in Critical Limb Ischemia Treatment Using Adipose-Derived Stem Cell Therapeutic Factor Concentrate and Extracellular Matrix Microparticles.

Med Sci Monit 2018 Jan 26;24:511-522. Epub 2018 Jan 26.

NeuroFX, LLC, Indianapolis, IN, USA.

BACKGROUND Paracrine factors secreted by adipose-derived stem cells can be captured, fractionated, and concentrated to produce therapeutic factor concentrate (TFC). The present study examined whether TFC effects could be enhanced by combining TFC with a biological matrix to provide sustained release of factors in the target region. MATERIAL AND METHODS Unilateral hind limb ischemia was induced in rabbits. Ischemic limbs were injected with either placebo control, TFC, micronized small intestinal submucosa tissue (SIS), or TFC absorbed to SIS. Blood flow in both limbs was assessed with laser Doppler perfusion imaging. Tissues harvested at Day 48 were assessed immunohistochemically for vessel density; in situ hybridization and quantitative real-time PCR were employed to determine miR-126 expression. RESULTS LDP ratios were significantly elevated, compared to placebo control, on day 28 in all treatment groups (p=0.0816, p=0.0543, p=0.0639, for groups 2-4, respectively) and on day 36 in the TFC group (p=0.0866). This effect correlated with capillary density in the SIS and TFC+SIS groups (p=0.0093 and p=0.0054, respectively, compared to placebo). A correlation was observed between miR-126 levels and LDP levels at 48 days in SIS and TFC+SIS groups. CONCLUSIONS A single bolus administration of TFC and SIS had early, transient effects on reperfusion and promotion of ischemia repair. The effects were not additive. We also discovered that TFC modulated miR-126 levels that were expressed in cell types other than endothelial cells. These data suggested that TFC, alone or in combination with SIS, may be a potent therapy for patients with CLI that are at risk of amputation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5795917PMC
http://dx.doi.org/10.12659/msm.905442DOI Listing
January 2018

Non-Hematopoietic Essential Functions of Bone Marrow Cells: A Review of Scientific and Clinical Literature and Rationale for Treating Bone Defects.

Orthop Rev (Pavia) 2015 Dec 28;7(4):5691. Epub 2015 Dec 28.

Hôspital Henri Mondor , Creteil, France.

Hematopoiesis as the only essential function of bone marrow cells has been challenged for several decades through basic science (in vitro and in vivo) and clinical data. Such work has shed light on two other essential functions of bone marrow cells: osteopoiesis and angio-genesis/vasculogenesis. Clinical utility of autologous concentrated bone marrow aspirate (CBMA) has demonstrated both safety and efficacy in treating bone defects. Moreover, CBMA has been shown to be comparable to the gold standard of iliac crest bone graft (ICBG), or autograft, with regard to being osteogenic and osteoinductive. ICBG is not considered an advanced therapy medicinal product (ATMP), but CBMA may become regulated as an ATMP. The European Medicines Agency Committee for Advanced Therapies (EMA:CAT) has issued a reflection paper (20 June 2014) in which reversal of the 2013 ruling that CBMA is a non-ATMP has been proposed. We review bone marrow cell involvement in osteopoiesis and angiogenesis/vasculogenesis to examine EMA:CAT 2013 decision to use CBMA for treatment of osteonecrosis (e.g, of the femoral head) should be considered a non-ATMP. This paper is intended to provide discussion on the 20 June 2014 reflection paper by reviewing two non-hematopoietic essential functions of bone marrow cells. Additionally, we provide clinical and scientific rationale for treating osteonecrosis with CBMA.
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http://dx.doi.org/10.4081/or.2015.5691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703908PMC
December 2015

Laboratory-Based Markers as Predictors of Brain Infarction During Carotid Stenting: a Prospective Study.

J Atheroscler Thromb 2016 Jul 19;23(7):839-47. Epub 2016 Jan 19.

Department of Neurology, Comprehensive Stroke Center, University Hospital Ostrava.

Aim: New ischemic lesions in the brain can be detected in approximately 50% of patients undergoing carotid artery stenting (CAS). We wished to discover the laboratory-based predictors of new infarctions in the brain after CAS.

Methods: All consecutive patients with internal carotid artery stenosis of ≥70% with indication for CAS were enrolled in a prospective study for 16 months. All patients used dual antiplatelet therapy for ≥7 days before CAS. Neurologic examination and magnetic resonance imaging (MRI) of the brain were undertaken before and at 24 h after CAS. Samples of venous blood were collected at <24 h before CAS for the evaluation of hematology, reticulocytes, coagulation markers (PT, APTT, Fbg, Clauss), vWF antigen, PAI-1 activity, PAI-1 polymorphism 4G/5G, and the multiplate (aspirin and clopidogrel) resistance test. Blood samples for the assessment of anti-Xa activity were collected during CAS. Differences in the values of laboratory markers between patients with and without new ischemic lesions of the brain on control MRI were evaluated.

Results: The cohort comprised 81 patients (53 males; mean age, 67.3±7.2 years). New ischemic infarctions in the brain on control MRI were found in 46 (56.8%) patients. Three of seven patients with resistance to aspirin or clopidogrel had a new ischemic infarction in the brain. No significant differences for particular markers were found between patients with and without an ischemic lesion in the brain.

Conclusion: A high risk of a new ischemic infarction in the brain was detected in patients undergoing CAS, but a laboratory-based predictor of such an infarction could not be identified.
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http://dx.doi.org/10.5551/jat.31799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399266PMC
July 2016

Therapeutic Potential of Adipose-Derived Therapeutic Factor Concentrate for Treating Critical Limb Ischemia.

Cell Transplant 2016 30;25(9):1623-1633. Epub 2015 Oct 30.

Radiodiagnostic Institute, University Hospital Ostrava, Ostrava, Czech Republic.

Transplantation of adipose-derived stem cells (ADSCs) is an emerging therapeutic option for addressing intractable diseases such as critical limb ischemia (CLI). Evidence suggests that therapeutic effects of ADSCs are primarily mediated through paracrine mechanisms rather than transdifferentiation. These secreted factors can be captured in conditioned medium (CM) and concentrated to prepare a therapeutic factor concentrate (TFC) composed of a cocktail of beneficial growth factors and cytokines that individually and in combination demonstrate disease-modifying effects. The ability of a TFC to promote reperfusion in a rabbit model of CLI was evaluated. A total of 27 adult female rabbits underwent surgery to induce ischemia in the left hindlimb. An additional five rabbits served as sham controls. One week after surgery, the ischemic limbs received intramuscular injections of either (1) placebo (control medium), (2) a low dose of TFC, or (3) a high dose of TFC. Limb perfusion was serially assessed with a Doppler probe. Blood samples were analyzed for growth factors and cytokines. Tissue was harvested postmortem on day 35 and assessed for capillary density by immunohistochemistry. At 1 month after treatment, tissue perfusion in ischemic limbs treated with a high dose of TFC was almost double (p < 0.05) that of the placebo group [58.8 ± 23 relative perfusion units (RPU) vs. 30.7 ± 13.6 RPU; mean ± SD]. This effect was correlated with greater capillary density in the affected tissues and with transiently higher serum levels of the angiogenic and prosurvival factors vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF). The conclusions from this study are that a single bolus administration of TFC demonstrated robust effects for promoting tissue reperfusion in a rabbit model of CLI and that a possible mechanism of revascularization was promotion of angiogenesis by TFC. Results of this study demonstrate that TFC represents a potent therapeutic cocktail for patients with CLI, many of whom are at risk for amputation of the affected limb.
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http://dx.doi.org/10.3727/096368915X689767DOI Listing
November 2017

Outcome predictors in acute basilar artery occlusion.

Can J Neurol Sci 2014 May;41(3):368-74

Objective: to identify predictors of good outcome in acute basilar artery occlusion (Bao). Background: acute ischemic stroke (aiS) caused by Bao is often associated with a severe and persistent neurological deficit and a high mortality rate.

Methods: the set consisted of 70 consecutive aiS patients (51 males; mean age 64.5 ± 14.5 years) with Bao. the role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30- and 90-day outcome was assessed using the modified rankin scale with a good outcome defined as a score of 0– 3.

Results: the following statistically significant differences were found between patients with good versus poor outcomes: mean age (54.2 vs. 68.9 years; p=0.0001), presence of arterial hypertension (52.4% vs. 83.7%; p=0.015), diabetes mellitus (9.5% vs. 55.1%; p=0.0004) and severe stroke (14.3% vs. 65.3%; p=0.0002), neurological deficit at time of treatment (14.0 vs. 24.0 median of national institutes of health Stroke Scale [nihSS] points; p=0.001), successful recanalization (90.0% vs. 54.2%; p=0.005), change in neurological deficit (12.0 vs. 1.0 median difference of nihSS points; p=0.005). Stepwise binary logistic regression analysis identified age (or=0.932, 95% Ci=0.882–0.984; p=0.012), presence of diabetes mellitus (or=0.105, 95% Ci=0.018-0.618; p=0.013) and severe stroke (or=0.071, 95% Ci=0.013-0.383; p=0.002) as significant independent negative predictors of good outcome.

Conclusions: in the present study, higher age, presence of diabetes mellitus and severe stroke were identified as significant independent negative predictors of good outcome.
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http://dx.doi.org/10.1017/s0317167100017327DOI Listing
May 2014

Addition of platelet concentrate to dermo-epidermal skin graft in deep burn trauma reduces scarring and need for revision surgeries.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014 Jun 27;158(2):242-58. Epub 2013 Sep 27.

Institute of Radiodiagnostic and Vice-President for Science and Research, University Hospital Ostrava, Czech Republic.

Background: [corrected] Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues.

Methods: We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses.

Results: We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings.

Conclusions: Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1-3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1-7 days), which normalized over the subsequent 7 and 90 days.
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http://dx.doi.org/10.5507/bp.2013.070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474322PMC
June 2014

Immunological and autoimmune considerations of Autism Spectrum Disorders.

J Autoimmun 2013 Aug 15;44:1-7. Epub 2013 Jul 15.

Autism Spectrum Disorders (ASD) are a group of heterogeneous neurodevelopmental conditions presenting in early childhood with a prevalence ranging from 0.7% to 2.64%. Social interaction and communication skills are impaired and children often present with unusual repetitive behavior. The condition persists for life with major implications for the individual, the family and the entire health care system. While the etiology of ASD remains unknown, various clues suggest a possible association with altered immune responses and ASD. Inflammation in the brain and CNS has been reported by several groups with notable microglia activation and increased cytokine production in postmortem brain specimens of young and old individuals with ASD. Moreover several laboratories have isolated distinctive brain and CNS reactive antibodies from individuals with ASD. Large population based epidemiological studies have established a correlation between ASD and a family history of autoimmune diseases, associations with MHC complex haplotypes, and abnormal levels of various inflammatory cytokines and immunological markers in the blood. In addition, there is evidence that antibodies that are only present in some mothers of children with ASD bind to fetal brain proteins and may be a marker or risk factor for ASD. Studies involving the injection of these ASD specific maternal serum antibodies into pregnant mice during gestation, or gestational exposure of Rhesus monkeys to IgG subclass of these antibodies, have consistently elicited behavioral changes in offspring that have relevance to ASD. We will summarize the various types of studies associating ASD with the immune system, critically evaluate the quality of these studies, and attempt to integrate them in a way that clarifies the areas of immune and autoimmune phenomena in ASD research that will be important indicators for future research.
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http://dx.doi.org/10.1016/j.jaut.2013.05.005DOI Listing
August 2013

A controlled trial of revascularization in acute stroke.

Radiology 2013 Mar 11;266(3):871-8. Epub 2012 Dec 11.

Comprehensive Stroke Center, Department of Neurology, Faculty of Medicine, Ostrava University and University Hospital Ostrava, 17 Listopadu 1790, CZ-708 52 Ostrava-Poruba, Czech Republic.

Purpose: To compare safety and utility of intraarterial revascularization with use of stents to no revascularization in patients who either failed to respond to intravenous thrombolysis (IVT) or have contraindications to IVT.

Materials And Methods: The case-control study was approved by local ethics committees; all patients signed informed consent. One hundred thirty-one patients (74 men; mean age, 65.9 years ± 12.3; range, 25-86 years) with acute ischemic stroke (AIS) due to middle cerebral artery (MCA) occlusion were enrolled; 75 underwent IVT. No further recanalization therapy was performed in 26 (35%) IVT-treated patients with MCA recanalization (group 1). Patients with IVT failure after 60 minutes were allocated to endovascular treatment (group 2A) or no further therapy (group 2B). Patients with contraindication to IVT were allocated to endovascular treatment within 8 hours since AIS onset (group 3A) or to no recanalization therapy (group 3B). Neurologic deficit at admission, MCA recanalization, symptomatic intracerebral hemorrhage (SICH), and 3-month clinical outcome were evaluated. Favorable clinical outcome was defined as modified Rankin scale score 0-2 at 3 months after stroke onset. Two-sided Mann-Whitney U test, independent samples t test, Fisher exact test, multivariate logistic regression analysis of baseline variables, and complete MCA recanalization for the prediction of favorable clinical outcome were used for statistical evaluation.

Results: Median National Institutes of Health Stroke Scale score at admission was 13.5, 16.0, 15.5, 15.0, and 16.0 in groups 1, 2A, 2B, 3A, and 3B, respectively (P > .05); SICH occurred in one of 26 (3.8%), one of 23 (4.3%), one of 26 (3.8%), one of 31 (3.2%), and one of 25 (4.0%) patients, respectively (P > .05). MCA recanalization after endovascular treatment was achieved in 50 of 54 (92.6%) patients. Favorable outcome was significantly different between groups 2A and 2B (10 of 23 [43.5%] and four of 26 [15.4%], respectively; P = .03) and groups 3A and 3B (14 of 31 [45.2%] and two of 25 [8.0%], respectively; P = .004) and was dependent on MCA recanalization (odds ratio, 5.55; P = .006).

Conclusion: In this controlled trial, intraarterial revascularization with stents was an effective and safe-effective treatment option in patients with acute MCA occlusion with contraindication to IVT or after IVT failure.
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http://dx.doi.org/10.1148/radiol.12120798DOI Listing
March 2013

Safety and efficacy of surgical treatment of carotid stump syndrome: pilot study.

Ann Vasc Surg 2012 Aug 22;26(6):797-801. Epub 2012 May 22.

Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic.

Surgical exclusion of the internal carotid artery (ICA) stump combined with endarterectomy of the external carotid artery is an established treatment approach. The aim of this pilot study was to compare the risk of cerebrovascular events between surgical treatment and best medical treatment in patients with ICA occlusion and carotid stump syndrome. Forty patients (23 males; age: 43-80 years; mean age: 61.1 ± 9.0 years) with carotid occlusion and carotid stump syndrome were enrolled. Ten patients with asymptomatic ICA occlusion and 10 patients with symptomatic ICA occlusion and carotid stump syndrome were enrolled to the best medical therapy group. Patients with chronic ICA occlusion, carotid stump syndrome, and one (15 patients) or recurrent (three patients) episodes of ipsilateral stroke or transient ischemic attack were enrolled to the surgical group. Neurological examination was undertaken on the day of randomization and then every 6 months in all patients for 4 years. All vascular events and death were recorded. Only one vascular event occurred in patients with symptomatic ICA occlusion without recurrent stroke or transient ischemic attack who were treated medically. No other vascular event was noted in the other subgroups. One patient with symptomatic carotid occlusion without recurrent stroke died due to myocardial infarction 6 months after surgery. Surgical treatment of carotid stump syndrome seems to be a safe procedure. Nevertheless, the benefit of a surgical approach in comparison with the best medical treatment is not clear.
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http://dx.doi.org/10.1016/j.avsg.2011.11.034DOI Listing
August 2012

[Metabolism monitoring with microdialysis in the intensive care].

Cas Lek Cesk 2011 ;150(11):605-9

Anesteziologicko resuscitacní klinika FN, Ostrava.

Therapy of haemorrhagic shock presents a huge challenge nowadays. Changes in circulation and metabolism are preceded with changes in cells, vessels and extracellular fluid. The main disorder takes place in microcirculation. Monitoring of extracellular fluid is possible with microdialysis. This method was verified on animal models and a became base of many clinical examinations in the world. First of all it is monitoring of lactate, pyruvate, glucose and glycerole as main markers of cell metabolism. Tissue condition can be described not only with absolute values but also as relations between individual parameters e.g. lactate/pyruvate and lactate/glucose. These values do not only inform us about forthcoming change from aerobic to anaerobic metabolism but also about the degree of reperfusion. Precious information about mitochondrial dysfunction which is the essence of multiorgan dysfunction in intensive care is collected as well. Based on changes we can asses the quality of resuscitation care together with speed of shock elimination, increasing oxygen delivery and mitochondrial dysfunction treatment.
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February 2012

Prior use of antiplatelet therapy can be associated with a higher chance for early recanalization of the occluded middle cerebral artery in acute stroke patients treated with intravenous thrombolysis.

Eur Neurol 2012 13;67(1):52-6. Epub 2011 Dec 13.

Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School, Olomouc, Czech Republic.

Background: The early recanalization (ER) of an occluded cerebral artery is important for clinical improvement in acute ischemic stroke. The aim of the study was to assess the possible association between the prior use of antiplatelets (AP) and ER of occluded middle cerebral artery (MCA) after intravenous thrombolysis (IVT).

Methods: In 146 consecutive acute ischemic stroke patients presenting with occluded MCA and treated with IVT, the ER and incidence of symptomatic intracerebral hemorrhage (SICH) were compared according to the presence or absence of prior AP use. ER was assessed by transcranial Doppler or digital subtraction angiography within 2 h after the end of IVT.

Results: Fifty-six patients (28 males, mean age: 69.8 ± 9.8 years) used AP and 90 patients were AP naïve (51 males, mean age: 65.8 ± 12.5 years). Prior AP use was associated with a higher rate of early MCA recanalization (53.6 vs. 29.5% in AP naïve, p = 0.007) and was shown as a predictor of ER (OR: 2.30, 95% CI: 1.14-4.65; p = 0.020) in unadjusted analysis. No difference was found in the occurrence of SICH.

Conclusion: Prior use of AP was associated with a higher rate of ER of occluded MCA, but with no increase of SICH after IVT.
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http://dx.doi.org/10.1159/000333064DOI Listing
June 2012

Detection of intracranial arterial stenosis using transcranial color-coded duplex sonography, computed tomographic angiography, and digital subtraction angiography.

J Ultrasound Med 2011 Aug;30(8):1069-75

Department of Neurology, Ostrava Medical School and University Hospital, Ostrava, Czech Republic.

Objectives: The aim of this retrospective study was to compare intracranial arterial stenosis in patients with stroke using 3 different methods: transcranial color-coded duplex sonography, computed tomographic (CT) angiography, and digital subtraction angiography in a common clinical practice.

Methods: Sixty-seven patients (47 male and 20 female; age range, 23-79 years; mean age ± SD, 62.0 ± 9.5 years) were enrolled in this study over 40 months. All patients underwent examinations of the intracranial arteries using transcranial color-coded sonography, CT angiography, and digital subtraction angiography. Findings were divided into 4 groups: normal, mild stenosis (<50%), severe stenosis (50%-99%), and occlusion.

Results: Because of technical reasons or an insufficient bone window, 465 of 536 arterial segments in 67 patients were evaluated; 12 stenotic and 15 occluded segments were detected using digital subtraction angiography. The sensitivity, specificity, positive predictive value, and negative predictive value of transcranial color-coded sonography and CT angiography in comparison with digital subtraction angiography as a reference standard were 88.9%, 94.8%, 51.1%, and 99.3% and 81.5%, 98.7%, 78.6%, and 98.6%, respectively. The agreement between transcranial color-coded sonography and CT angiography was 93.8% (κ = 0.559); between transcranial color-coded sonography and digital subtraction angiography, it was 93.9% (κ = 0.588); and between CT angiography and digital subtraction angiography, it was 96.6% (κ = 0.697).

Conclusions: Moderate agreement was found between CT angiography, transcranial color-coded sonography, and digital subtraction angiography in the evaluation of intracranial stenosis. Computed tomographic angiography and digital subtraction angiography are sufficient for assessment of the diagnosis.
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http://dx.doi.org/10.7863/jum.2011.30.8.1069DOI Listing
August 2011

Should mechanical embolectomy devices be used in routine clinical practice?

J Neural Transm (Vienna) 2011 Aug 19;118(8):1131-8. Epub 2011 Feb 19.

Department of Neurology, Faculty Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17.listopadu 1790, 70852, Ostrava, Czech Republic.

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http://dx.doi.org/10.1007/s00702-010-0557-6DOI Listing
August 2011

Moyamoya disease is associated with endothelial activity detected by anti-nestin antibody.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010 Jun;154(2):159-62

Palacky University, Olomouc, Czech Republic.

Aim: To describe the case history and new histopathological findings of a young woman suffering from moyamoya disease.

Methods: The patient underwent brain computed tomography, magnetic resonance imaging and brain angiography. Vessel samples of a. temporalis superficialis were processed by standard histopathological and immunohistochemical methods by analysis of VEGF, VEGFR and nestin expression.

Results: Brain angiography revealed both internal carotid artery stenoses and stenoses of the anterior cerebral arteries. Stenotic parts of vessels were accompanied by coiled and elongated vessels with a picture of "smoke puffs carried away by breeze" after contrast medium application. Histological examination showed: obstruction of lumen, fibrocellular intimal thickening, tortuosity and disruption of internal elastic lamina. Imunohistochemistry confirmed a defect of the internal elastic membrane of the muscular arteria and progressive intimal thickening accompanied by abnormal smooth muscle cells and, VEGF/VEGFR expression in intima. Nestin positivity in endothelium of arteria indicated that endothelial cells are activated.

Conclusion: We found that the endothelium of affected vessels is nestin positive. This, together with the finding of VEGF/VEGFR expression, might suggest an active angiogenetic process We present a new conception of pathogenesis but further studies with higher number of patients are necessary to elucidate the role of these growth factors in the moyamoya disease.
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http://dx.doi.org/10.5507/bp.2010.024DOI Listing
June 2010

Transcranial duplex sonography and CT angiography in acute stroke patients.

J Neuroimaging 2010 Jul 13;20(3):240-5. Epub 2009 Feb 13.

Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic.

Acute occlusion of cervical or intracranial arteries is the most common cause of ischemic stroke (IS). The aims of the current study were to compare the occurrence of acute pathologic findings in intracranial arteries using transcranial color-coded sonography (TCCS) and computed tomographic angiography (CTA) performed within 3 hours of IS onset and to assess the correlation between the vascular findings on admission and the patient's clinical state on admission and 3 months after the IS. Forty-five consecutive patients with an acute IS were included in the prospective study during an 18-month period. All patients underwent CTA and TCCS within the first 3 hours of symptom onset. A high rate of pathologic findings in the intracranial circulation was found (70.9% in CTA and 77.4% in TCCS examinations). The CTA and TCCS findings with respect to the intracranial arteries were consistent in 87.1% of cases (Cohen's kappa, .797). The sensitivity, specificity, and positive and negative predictive values achieved with TCCS in patients with middle cerebral artery main stem occlusion were 92.3%, 94.4%, and 92.3% and 94.4%, respectively. There was no correlation between the patient's clinical status on admission and 3 months after the onset of the IS and the CTA or the TCCS findings (P > .1 in all cases). A substantial agreement was found between TCCS and CTA in the detection of pathologic findings in intracranial vessels in acute stroke patients. Both methods can be used for this purpose.
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http://dx.doi.org/10.1111/j.1552-6569.2008.00358.xDOI Listing
July 2010

Brain single photon emission tomography and hypercapnia test in testing cerebrovascular reserve capacity, in Moya moya disease.

Hell J Nucl Med 2008 Sep-Dec;11(3):179-81

Nuclear Medicine Department, Ostrava Faculty Hospital, Chech Republic.

Moya moya is a progressive cerebral occlusive vasculopathy, rare in European countries. We describe a case of a young woman with right-hand side hemiparesis, mixed expressive aphasia, organic psychosyndrome and cognitive malfunction. Detailed imaging methods displayed bilateral stenosis of the internal carotid artery, bilateral ischemic cerebral changes and bilateral perfusion deficit, which guided us to the final diagnosis. Before the bypass surgery, cerebrovascular reserve capacity (vasoreactivity), by the brain single photon emission tomography and hypercapnia, were assessed and the lower cerebrovascular reserve was demonstrated. Bilateral bypass surgery with extracranial-intracranial anastomosis, improved the neurological deficit. Diagnosis was confirmed by histological examination of the vessel wall specimen.
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June 2009