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Abstract The research of novel implantable medical devices is one of the most attractive, yet complex areas in the biomedical field. The design and development of sufficiently small devices working in an in vivo environment is challenging but successful encapsulation of such devices is even more so. Industry-standard methods using glass and titanium are too expensive and tedious, and epoxy or silicone encapsulation is prone to water ingress with cable feedthroughs being the most frequent point of failure. This paper describes a universal and straightforward method for reliable encapsulation of circuit boards that achieves ISO10993 compliance. A two-part PVDF mold was machined using a conventional 3-axis machining center. Then, the circuit board with a hermetic feedthrough was placed in the mold and epoxy resin was injected into the mold under pressure to fill the cavity. Finally, the biocompatibility was further enhanced with an inert P3HT polymer coating which can be easily formulated into an ink. The biocompatibility of the encapsulants was assessed according to ISO10993. The endurance of the presented solution compared to silicone potting and epoxy potting was assessed by submersion in phosphate-buffered saline solution at 37 °C. The proposed method showed superior results to PDMS and simple epoxy potting.

Background/Aims The aim of this study was to investigate the use of non-exposure endoscopic wall-inversion surgery (NEWS) and the combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) in gastric tumors. Methods We reviewed all cases of NEWS and CLEAN-NET performed in the department of surgery of the Royal Vinohrady Teaching Hospital. Results Our department performed 12 gastric tumor resections (NEWS, n=10 and CLEAN-NET, n=2) between March 2016 and February 2017. The cases chosen for these resections included predominantly submucosal tumors with no signs of dissemination or local invasion and early gastric carcinomas (T1SM1 and T1M), where tumor location made it impossible to use endoscopic submucosal dissection. R0 resection margins were confirmed in all the cases. Conclusions NEWS and CLEAN-NET allow en bloc non-exposed full-thickness gastric wall resection in a way that uses a “close first, cut later” approach to prevent seeding of the peritoneal cavity with tumor cells. These mini-invasive techniques combine laparoscopic and endoscopic techniques, and preserve the full function of the stomach.

Introduction. The aim of this study was to compare the indications, operative details, and clinical outcomes of nonexposed endoscopic wall-inversion surgery with endoscopic-navigated laparoscopic wedge resection of gastric submucosal tumours. Methods. Medical records were reviewed for patients who underwent nonexposed endoscopic wall-inversion surgery (NEWS) at the Faculty Hospital Kralovske Vinohrady and endoscopic-navigated laparoscopic wedge resection (LWR) at the Kepler University Hospital. Demographic, tumour, surgical, perioperative, and follow-up data were collected and compared. Results. Eleven patients underwent NEWS and twelve patients underwent LWR. NEWS was associated with a longer operating time and more frequent suture line bleeding (3 cases in the NEWS group versus 1 case in the LWR group). Negative resection margins were achieved in all NEWS procedures and in 11 of the LWRs. The difference in size between the tumour and the resected specimen was smaller in the NEWS group. Length of hospitalisation was similar between the two groups (NEWS=6.8 days, LWR=6.5 days). Follow-up gastroscopies at 12 months postoperatively revealed no signs of recurrence in any of the patients. Conclusion. Nonexposed endoscopic wall-inversion surgery is a new technique for the treatment of gastric tumours. It allows for more precise resections with more frequent achievement of negative resection margins than LWRs. Additionally, it may allow for better preservation of gastric function and limit communication between the gastric lumen and peritoneal cavity. The longer operating time and more frequent complications associated with the NEWS reflects the limited experience with these new techniques.

Background/Aims: To assess, in a prospective cohort study of 238 renal transplant patients, our hypothesis that elevated ADMA levels may be influenced by physical exercise and obesity. Methods: Blood samples before and after six months were obtained from 116 transplant patients participating in an aerobic exercise (Group I). A control group consisted of 122 matched transplant patients who did not exercise regularly (Group II). Results: There were no significant differences in ADMA levels between both groups before the training program (Group IB vs Group IIB). After six months of exercise, ADMA levels in Group I decreased (Group IB vs Group IA : 3.50 ± 0.45 vs 2.11 ± 0.35μmol/L; pA vs Group IIA : 2 11 ± 0 23 vs 3 25 ± 0 34μmol/L; p2) confirmed a smaller effect of exercise training (Group IBO vs Group IAO : 3 75 ± 0 52 vs 3 45 ± 0 45; pAO vs Group IIAO : 3.45 ± 0.45 vs 3.74 ± 0.62; p1C, insulin, and systolic BP were also affected by the training program. Conclusion: Elevated ADMA levels were significantly decreased by early exercise after renal transplantation. The effect of exercise was smaller in obese patients.

Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG) in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG) in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

Background: Visfatin is an adipocytokine produced primarily by visceral adipose tissue. In addition to its effect on the insulin receptor, it is a proinflammmatory cytokine with accumulating evidence for its rise in circulation, accompanying systemic inflammation. The aim of this study was to evaluate changes in serum visfatin levels in the early post-abdominal surgery period with serum levels of other proinflammatory cytokines, to determine whether it could be used as a marker of inflammation. Methods and Results: This was a prospective cross-sectional study of 42 patients undergoing elective laparotomic right hemicolectomy for adenocarcinoma colon. The parameters determined were visfatin, leptin, adiponectin, TNF α, interleukin-6 and C-reactive protein levels. The dynamics of change in these markers were assessed at +12, +24, +48, and +72 h after surgery. Serum levels of visfatin peaked as early as 24 h post-surgery, returning to normal after 72 h. TNF α and IL-6 levels reached their maximum 12 to 24 h later while CRP levels peaked after 72 h. Conclusions: Significantly increased serum levels of visfatin detected in the early period after abdominal surgery preceded increase in the levels of other proinflammatory markers including TNF α, IL-6, and CRP. Given its dynamics, visfatin could serve as an early predictor of the development of inflammatory changes in patients undergoing surgery, particularly those with obesity (BMI > 30 kg/m2).

The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes.A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year.Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p = 0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p = 0.021). Dual antiplatelet therapy was resumed more often (91.7%) in comparison to aspirin monotherapy (57.3%; p = 0.047), and vitamin K antagonist (56.3%; p = 0.042). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p = 0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%, 20 of them died due to cancer). Non-reinstitution of aspirin until discharge was associated with higher one-year mortality (17.6% vs. 34.8%; p = 0.018).Preoperatively interrupted antithrombotics were re-administrated at discharge only in half of patients with AF, less likely in male patients and those undergoing elective surgery. The presence of AF was recognized as a predictor of one-year mortality, especially if aspirin therapy was not resumed until discharge.ClinicalTrials.gov NCT01897220.