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Electromyographic and clinical evaluation of vincristine-induced peripheral neuropathy in pediatric patients after treatment of acute lymphoblastic leukemia and correlation with the Bruinkins-Oseretsky Test of Motor Proficiency Second edition
Bořilová, Karolína ; Jevič, Filip (advisor) ; Pánek, David (referee)
Title: Electromyographic and clinical evaluation of vincristine-induced peripheral neuropathy in pediatric patients after treatment of acute lymphoblastic leukemia and correlation with the Bruinkins-Oseretsky Test of Motor Proficiency Second Edition Objectives: The aim of this work was to characterize the neurological consequences of vincristine-induced peripheral neuropathy (VIPN) clinically and electromyographically and to evaluate motor skills of pediatric patients after the end of treatment of acute lymphoblastic leukemia. We also determined the relationship between the results of the clinical and electromyographic evaluation of VIPN and the correlation with the results of motor skills tests. Methods: The study involved 35 probands (19 girls and 16 boys) with a mean age of 10.7 years (SD ± 4.3) and a mean time since the last dose of vincristine of 2.3 years (SD ± 1.2). VIPN was assessed using a clinical pediatric-modified Total Neuropathy Score (ped-mTNS) and nerve conduction studies (NCS). Motor skills were assessed using the Bruinkins-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Results: The clinical presence of VIPN, according to ped-mTNS, was found in 20 % of probands. Abnormalities in nerve conduction studies were reported by 60.9 % of probands. Of these, 92.9 % had motor...
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Searching for and Evaluating the Severity of Endothelial Dysfunction in Children with Chronic Autoimmune Disease
Sýkorová, Aneta ; Jehlička, Petr (advisor) ; Urbanová, Zuzana (referee) ; Klásková, Eva (referee)
We aimed to evaluate the endothelial function by combining RHI measurements and specific biochemical markers in the children with possible risk of premature manifestation of atherosclerosis and in the control group of healthy children. In all, 124 children (of which 106 patients divided into five groups according to diagnosis - type 1 diabetes mellitus, Crohn's disease, cystic fibrosis, familial hypercholesterolemia and acute lymphoblastic leukemia and 18 healthy controls) were enrolled in the study. During the study, we measured RHI using a new plethysmographic method and further evaluated biochemical markers of endothelial dysfunction (ADMA, E-selectin, hsCRP and VCAM) and lipidogram in individual groups of children. The primary objective of our study was the determination of RHI and biochemical parameters in healthy subjects and in selected risk groups of children (type 1 diabetes mellitus, Crohn's disease, cystic fibrosis, familial hypercholesterolemia and children after successful treatment of acute lymphoblastic leukemia). At the same time, we compared patients from individual groups with the control group. We found significantly elevated RHI values in groups of children with type 1 diabetes, Crohn's disease, cystic fibrosis, and children after successful treatment of acute lymphoblastic leukemia....
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Impact of glucocorticoid treatment on musculosceletal system of pediatric patients with acute lymphoblastic leukemia.
Petráčková, Karolína ; Jevič, Filip (advisor) ; Šrámková, Lucie (referee)
This bachelor thesis aims to provide a general overview of complications of musculoskeletal system in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) undergoing chemotherapy treatment involving high cumulative doses of glucocorticoids. Musculoskeletal complications include steroid myopathy, osteonecrosis and reduced bone mineral density. The first part describes their basic pathophysiological mechanisms and the risk factors of their origin. The second part presents the current possibilities of muscle strength assessment and available exercise programs. Furthermore, diagnosis of osteonecrosis and bone mineral density are presented together with current possibilities of therapeutic intervention. The thesis also covers characteristics of muscle strength measuring methods and exercise programs along with presentation of the results of individual studies. In the discussion part, there are broken down the limits, advantages and disadvantages of using the muscle strength measuring methods and exercise programs in clinical practice.
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The Influence of Motivational Elements in Paediatric Physiotherapy Focused on the Patients with Acute Lymphoblastic Leukemia - Pilot Study
Chytrá, Markéta ; Jevič, Filip (advisor) ; Králová, Aneta (referee)
THE INFLUENCE OF MOTIVATIONAL ELEMENTS IN PAEDIATRIC PHYSIOTHERAPY FOCUSED ON THE PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA - PILOT STUDY Abstract The efficacy of acute lymphoblastic leukemia (ALL) treatment in childhood is still increasing and the quality of life of these children is starting to be the focus of interest. The physiotherapy affects in preventive and reactive way the late effects of treatment which may reduce the quality of life. An insufficient motivation of children can be a reason of a reduced adherence to a physiotherapeutic intervention. The goal of this study was to ascertain the influence of the motivational elements in the paediatric physiotherapy in the improvement of motor functions, the quality of life, the motivation to the exercise and the frequency of exercise. There were 9 patients diagnosed with ALL in the maintenance phase of treatment (average age 7,3 years, age range 5,2 - 10,1, 5 girls and 4 boys). All probands underwent a 6- weeks-excercise programme that contains the exercise from the DNS method, yoga for children and stretching. The assessment was performed by Bruninks-Oseretsky Test (BOT2), 6 minute walking test (6MWT), goniometric measurement of ankle joint dorsiflexion, Pediatric Quality of Life Inventory (PedsQL), Intrinsic Motivation Inventory (IMI) and the...
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Approaches to mTOR pathway inhibition in acute leukemic cell lines
Kolejáková, Veronika ; Mrvová, Silvia (advisor) ; Kojzarová, Martina (referee)
The mammalian target of rapamycin (mTOR) is a serine/threonine kinase regulating cell growth, proliferation, metabolism and survival. The mTOR pathway integrates stimuli from growth factors, nutrients, and cellular energy status and leads to downstream activation of Akt, 4E-BP1 and S6K. Phosphorylation of 4E-BP1 and S6K results in increased protein synthesis in addition to ribosome biogenesis and plays an important role in cell cycle progression. mTOR pathway is overactivated in numerous cancer types including the acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), which are both characterized by abnormal proliferation of white blood cells and low patient survival rate. Three distinct approaches that differ in efficiencies and research stages have been used to inhibit the mTOR pathway. Rapamycin and its derivatives are the most common inhibitors, but since they are not entirely specific, they provide only limited desirable outcomes. Dual inhibitors targeting mTOR as well as PI3K pathway have had several successes in treating both AML and ALL. However, the new generation of inhibitors such as PP-242 and Torin-1 are providing the most hopeful prospects for mTOR inhibition and long-term remission of acute leukemia.
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Lineage plasticity in normal and malignant lymphocyte precursors
Rezková Řezníčková, Leona
The classical scheme of hematopoiesis presumes early separation of lymphoid and myeloid precursors. Recently, more complex models are put forward, suggesting greater flexibility of hematopoiesis with progenitors sharing lymphoid and myeloid potential. Acute hybrid leukemia is a malignancy, in which it is not possible to assess unambiguously myeloid or lymphoid lineage of origin. The behaviour of those malignancies favors new models of hematopoiesis. Our work concentrated mainly on the research of childhood leukemias with lineage switch from lymphoid to myeloid lineage during induction treatment. Our task within this extensive project was to determine lineage assignment of leukemic blasts using detection of immunoglobulin and T-cell receptor gene rearrangements. We confirmed that myeloid cells derived during the treatment in all patients descend from the original lymphoid clone. We also investigated the expression of selected genes in those cases compared to common leukemia types. Lastly, we explored prognostic impact of TCR rearrangements (and thus lymphoid lineage commitment) in T-lineage leukemia.
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Heteroploidy in bone marrow cells of children with acute lymphoblastic leukemia (ALL)
Matějčková, Nicole ; Zemanová, Zuzana (advisor) ; Krylov, Vladimír (referee)
Acute lymphoblastic leukemia is the most common type of cancer in children. It is a very heterogenous disease in which many recurrent chromosomal abnormalities have been described. The most important chromosomal abnormalities associated with a good prognosis are t(12;21)(p13;q22) which result in ETV6/RUNX1 fusion and hyperdiploidy. On the contrary findings suggesting a poor prognosis are t(9;22)(q34;q11) leading to fusion gene BCR/ABL1, MLL rearrangements or hypodiploidy. Heteroploidy is one of the most frequent findings in childhood ALL. It is characterised by nonrandom gain or loss of chromosomes from diploid cells. One of the most important findings in childhood ALL is hyperdiploidy where a non-random gain of chromosomes is present. Hyperdiploidy has a favorable prognosis and the impact of additional structural aberations requires further research. Another prognostically important group of heteroploidy is hypodiploidy. It is a quite rare finding and has a very poor outcome. There are non-random acquired chromosome losses observed in hypodiploid cells. Hypodiploid cell line may be masked with a doubled hyperdiploid clone which makes it difficult to identify. Proper and early cytogenetical analysis of heteroploid cells is very important as it contributes assigning correct diagnosis and risk stratification,...
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The study of genetic changes of children patients suffering from the acute lymphoblastic leukemia (ALL) using mFISH / mBAND and micro-arrays.
Bártů, Linda ; Zemanová, Zuzana (advisor) ; Březinová, Jana (referee)
Acute lymphoblastic leukemia is the most common malignancy in children. The most important examination at the time of diagnosis includes karyotype of leukemic cells which divides patients into prognostic groups according to cytogenetic finding. In up to 90 % of patients the chromosomal aberrations with well known clinical significance are designated. One of cytogenetic type is high hyperdiploid ALL (51-68 chromosomes) associated with favorable prognosis. Nevertheless, relapses of the disease occur even in these children. One possible reason why this happens could be an increased genomic instability of leukemic cells that causes cryptic structural rearrangements. In a retrospective study, we examined a total of 232 children with newly diagnosed B-ALL using conventional cytogenetic analyses and interphase fluorescence in situ hybridization (I-FISH) with a panel of DNA probes (Abbott Vysis) in order to detect heteroploid cells. In patients with suspect cryptic structural chromosome aberrations, we analyzed the karyotypes in detail by multicolor FISH and multicolor banding (mFISH/mBAND; MetaSystems). The extent of aberrations was determined by comparative genomic hybridization on BAC arrays (array CGH; BlueGnome). Cell clones with high hyperdiploid karyotype were detected in a total of 102 children (44 %). In...
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Lineage plasticity in normal and malignant lymphocyte precursors
Rezková Řezníčková, Leona ; Froňková, Eva (advisor) ; Otáhal, Pavel (referee)
Klasické schéma vývoje hematopoetických buněk předpokládá časné oddělení lymfoidního a myeloidního prekurzoru. V poslední době jsou navrhovány složitější modely, které předpokládají větší flexibilitu hematopoezy a navrhují existenci progenitorů s lymfoidním i myeloidním potenciálem. Akutní hybridní leukémie jsou malignity, které podle různých kritérií nelze jednoznačně zařadit k lymfoidní nebo k myeloidní linii a jejichž chování spíše dává za pravdu novým modelům hematopoezy. Předkládaná práce se zabývala především výzkumem dětských leukémií s přesmykem z lymfoidní do myeloidní linie během indukční léčby. Jedná se o rozsáhlý projekt, v jehož rámci si diplomová práce si kladla za úkol určit liniové zařazení leukemických blastů pomocí detekce přestaveb genů pro imunoglobuliny a T-buněčné receptory (TCR). Potvrdili jsme, že myeloidní buňky derivované v průběhu léčby pochází u všech pacientů z původního lymfoidního klonu. Dále jsme u těchto případů zkoumali expresi vytipovaných genů ve srovnání s běžnými druhy leukémií. Třetí částí práce byl výzkum prognostického významu přítomnosti přestaveb TCR (a tedy příslušnosti k lymfoidní linii) u leukémií z T-lymfoidní řady.
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Continuous measurement of blood pressure
Kopčil, Petr ; Chmelař, Milan (referee) ; Nováková, Zuzana (advisor)
This paper deals with the physiology of cardiovascular system, explains elementary principles related to blood flow physiology and describes some basic mechanisms for regulation and blood pressure measurement. The paper also includes a description of the medical device, known as the Finometer (FMS, Netherlands), for continuous non-invasive blood pressure measurement and suggests a way to data export from this device to a text file. It introduces user friendly application to manage recorded data written in MATLAB. There is a statistical test to assess the difference between two statistical data files in the last chapter of this paper which includes a comparison our results with studies made in Czech Republic and other countries too.
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