Úvod: U 60 % nemocných s kolorektálním karcinomem jsou diagnostikovány jaterní metastázy (JMKRK), ať už v době stanovení diagnózy, nebo v průběhu léčby. Chirurgická léčba je jedinou potenciálně kurabilní metodou s pětiletým přežíváním dosahujícím cca 50 %. Jaterní resekci však podstoupí méně než 20 % pacientů s JMKRK. Společnou snahou onkologů a chirurgů je navýšit počet resekovaných pacientů. Jedním z postupů, jak navýšit resekabilitu JMKRK, je „liver first approach“ (LFA). Autoři prezentují vlastní předběžné výsledky této metody. Metody: Do multicentrického grantu IGA MZ NT 13660 – Hodnocení kvality multimodální péče u nemocných s jaterními metastázami kolorektálního karcinomu – bylo od září 2012 do ledna 2015 zařazeno v ÚVN 102 pacientů. LFA jsme použili u 12 pacientů (12 %). Po příznivé léčebné odpovědi neoadjuvantní systémové léčby jsme pacienty indikovali k resekci jater. U 11 pacientů se jednalo o mnohočetné (>4 meta) bilobární postižení. V jednom případě se jednalo o objemnou solitární metastázu pravého jaterního laloku. Primární tumor byl u 9 nemocných v rektu, u 3 v oblasti rektosigmatu, 3 pacienti měli derivační kolostomii, ostatní byli bez poruchy pasáže. Výsledky: U 11 pacientů jsme provedli R0 resekci jaterních metastáz, 3x jsme indikovali dvoufázovou hepatektomii s portální embolizací (PVE), 1x jsme pro progresi po PVE ustoupili od 2. fáze). Velkou resekci jsme provedli 7x, neanatomickou resekci včetně RFA 11x (6x v kombinaci s velkou resekcí). Perioperační mortalita byla nulová, morbidita 33 % (Dindo-Clavien >2). 10 pacientů absolvovalo adjuvantní chemoterapii, 7 z nich včetně radioterapie malé pánve pro lokálně pokročilý tumor rekta. U 7 pacientů (58 %) jsme doplnili resekci primárního tumoru. V současné době zemřeli na progresi onemocnění 2 pacienti (17 %), progresi onemocnění jsme zaznamenali u 6 pacientů (50 %). Závěr: LFA považujeme za vhodný především u pacientů s generalizovaným tumorem rekta, kdy lze po resekci jater adjuvantní systémovou léčbu kombinovat s radioterapií malé pánve. Otázkou zůstává načasování operace primárního tumoru, kdy je nutné vyloučit recidivu jaterních metastáz, která se objevuje u více než 50 % pacientů. Profit LFA musí být prokázán randomizovanými studiemi., Introduction: Liver metastases are diagnosed in 60% of patients with colorectal cancer, both at the time of diagnosis or later in the course of their management. Surgical treatment is the sole potentially curable method with 5–year overall survival of approximately 50%. However, only less than 20% of patients underwent liver resection. A joint effort of medical oncologists and surgeons is to increase the numbers of resected patients. The “liver first approach” (LFA) is one of approaches aimed at increasing resecability. The authors present their preliminary results using this method. Methods: 102 patients were included in the multicentre study supported by the grant IGA NT 13660 − Evaluation of quality of multimodal treatment for patients with colorectal cancer liver metastases – conducted at the Central Military Hospital between September 2012 and January 2015. We used LFA in 12 patients (12%). Patients were indicated for liver resection based on good response to neoadjuvant systemic therapy. Multiple bilobar liver involvement (>4 metastases) was present in 11 cases and one large solitary metastasis in the right liver lobe in one case. The primary tumor was located in the rectum in 9 patients, in the rectosigmoid in 3 patients; 3 patients had a colostomy. Others showed no signs of bowel obstruction. Results: We have performed R0 resections in 11 cases, and two-stage hepatectomy with portal vein embolisation was indicated 3 times (in one case we did not finish the second stage due to quick progression after PVE). We performed major resections 7 times, along with sever extraanatomic resections, incl. 11 RFA (6 times in combination with major resections). Perioperative mortality was 0%, morbidity 33% (Dindo-Clavien >2). Ten patients underwent adjuvant chemotherapy, in 7 cases including radiotherapy of the small pelvis due to a local advanced primary tumor. Resection of the primary tumor was done in 7 patients (58%). Two patients died recently because of disease progression (17%); progression was observed in 6 patients (50%). Conclusion: We deem the LFA suitable especially for patients with metastatic rectal tumors where adjuvant systemic therapy can be combined with radiotherapy. The timing of the resection of the primary tumor still remains a question: it is necessary to rule out potential recurrence of liver metastases, which affected more than 50% of the patients. The benefit of LFA must be confimed by randomised studies., and J. Pudil, S. Batko, K. Menclová, M. Bláha, M. Ryska
This paper uses a corpus of 14 hours of recorded interactions to analyze the “normative” and “strategic” honorifics usage of speakers of Korean as a second language. I define “normative” honorifics as usage that reflects recognized “power”, “distance” and “formality” factors. “Strategic” honorifics usage breaks from these norms, is pragmatically “marked” and is motivated by interactional goals. Previous studies into the honorifics usage of speakers of Korean as a second language focus on analysis of “errors” judged against prescriptive norms. However, the current paper adopts an interactional socio-pragmatic perspective and looks at the ideology and specific intentions that underlie second language usage. According to my data, in comparison with native interaction, second language speaker discourse displays less variation according to normative factors but may show more marked strategic alterations. Regarding normative usage, speakers prefer to establish equal relationships and minimize “power” differences. As for strategic use, speakers may alternate honorific levels according to the sensitivity of the situation or the illocutionary force of particular utterances. I explain these differences with reference to conflicting ideologies as to language usage between Korean and “Western” cultures, prevalent during the interview process. I conclude the paper by discussing the implications for Korean applied linguistics.
Historically, the main focus of the study of housing in advanced economies has been on houses that meet the accommodation needs of households: houses as the main residence of families. In recent decades there has been the growth in the numbers of houses used for purposes other than as a main residence, for example in the forms of the recent global spread of Airbnb and of foreign engagement in housing as an investment tool; alongside a set of ‘for housing’ houses (FHH) another, overlapping, set of ‘not for housing’ houses (NFHH) is emerging. The present paper begins by identifying four types of NFHH, and considers the significance of their growth. It argues that while the NFHH sector is relatively small it has large impacts, and these are such that they challenge housing researchers and policy makers to develop additional ways of looking at housing systems.
The cuticular structure of juveniles of several oribatids of different families with wrinkled cuticles were compared: Hermannia gibba, Tectocepheus velatus, Scutovertex minutus, Achipteria coleoptrata and Eupelops occultus. Both the surface and internal structures of the "plissée" were studied. Light microscopy revealed several patterns in mites studied with Masson's triple stain and these results were supported by TEM. Although the "plissée" looks similar at the body surface, the structure and ultrastructure differ among groups. Some types of wrinkling is supported by small muscles, probably for changing body shape. Differences in the structure of the cuticle of the prosoma and opisthosoma were observed. The differences in the wrinkling in the cuticle in diferent lines is associated with change in the body shape in response to different moisture conditions.
This article examines the administration of rescue operations to save people from drowning and the distribution of rewards to rescuers in Bohemia during the 1780s and 1790s. Based on documented interrogations and official records, the article looks at the investigatory process, the conditions rescuers had to fulfil in order to apply for a reward from the Bohemian Gubernium, and the role of other actors in this process, such as witnesses and doctors. The study departs from the concept of biopolitics developed by French philosopher Michel Foucault and shows how the state authorities tried to foster mutual solidarity among town dwellers. While Enlightenment thinkers continued to stress the role of "love for human beings" (Menschenliebe), i.e. universal interpersonal solidarity, the elites held the view that the biggest motivation for anyone to save a person from drowning was monetary reward. The aim of the enlighteners, however, was to encourage people to embrace the ideal of "Menschenliebe" and to fully identify with it - hence their emphasis on cases of selfless acts, especially in newspapers and popular literature. Besides that, the article analyses the trend towards the medicalization of society in the Enlightenment period and changes in attitudes to death., Ondřej Hudeček., and Obsahuje bibliografické odkazy
Stručná historická sonda do lokality nazvané "rakouská Cremona" proslulé výrobou hudebních nástrojů (Luby, okres Cheb) a jmenný přehled jednotlivých výrobců a prodejců hudebních nástrojů.