MSP CLINICAL RESEARCH | 09:00

IMPACT OF AUTOFLUORESCENCE ASSISTED SURGERY ON THE LONG TERM TREATMENT SUCCESS IN ORAL SQUAMOUS CELL CARCINOMA (OSCC)

Author: Lucie Svobodová (1)
Supervisor: Petr Pošta (1)
(1) Department of Stomatology, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen
State-of-the-Art: Lip and oral cavity cancer is the 16th most common worldwide malignancy with relatively high mortality (90 % of these are OSCC). The incidence of OSCC in the Czech Republic is around 680 new cases each year with a rising tendency. Surgery still has the best curative outcome and a clear resection margin is crucial. Several methods have been used to determine healthy and malignant cells and to assist the surgeon to set the appropriate resection margin. The impact of most of those methods on the long term treatment success is unclear. The effect of autofluorescence on evaluating the tumor range seems to be significant ad have been published in several articles (Poh et al., Pošta et al.). We evaluate the effect of autofluorescence on patient survival with OSCC in our study.
Objective: The positive resection margin in OSCC is considered to be a negative prognostic marker. The autofluorescence is proved to be efficient in mucosal margins evaluation. We are assessing the impact of autofluorescence on 3 and 5 years survival rates.
Material and Methods: A total number of 96 patients suffering from OSCC were randomized into a study and a control group without statistically significant differences. Patients in study group were peri- or preoperatively examined with VELscope, which was accompanied by the marking of the range of a loss of fluorescence, and this was followed by surgical resection at least 3 mm behind the markings. In control group the tumor was resected with at least 1 cm macroscopically healthy tissue rim. According to the final stage, the adjuvant treatment was applied following the NCCN guidelines. After the treatment all patients undergo at least 5 year follow-up and the curative results are evaluated. All recorded data were processed with the help of Ing. Petr Hošek, Ph.D. and the programme Statistica.
Results & Discussion: Of the total of 96 patients recruited in this study, both study group and control group counted 48 patients. In study group, 3-year DFS was 61.1 %, in control group it was 63.1 %, 5-year DFS was 56.1 % in study group vs. 56.3 % in control group. Study group had 3-year DSS of 87.7 %, OS of 72.1 % whereas control group 3-year DSS of 71.2 %, OS 68.3 % and 5-year DSS in study group was 87.7 %, OS 67.3 % vs. DSS 63.7 % and OS 57.9 % in control group. The survival rates do not differ significantly across control and study group. The explanation for this is that autofluorescence examination only influences the quality of mucosal resection margin, but other predictors, mainly deep resection margin, remain the same and may have negative impact on the treatment success.
Conclusion: Resection following autofluorescence defined margins has a positive impact on quality of mucosal resection margin, and therefore has a positive effect on surgical treatment success. The impact of direct autofluorescence on long-term treatment success still remains questionable.
Study program: Master´s degree – General Medicine | Year of study: 3
ID: 1104

Mapping the vascular anatomy of the Presticke Black Pied Breed pig, our pilot result

Authors: Claudia Maria Clara Sbiroli (2), Marie Zavřelová (2), Kamila Kunčarová (2)
Supervisor: Patrik Mik (1)
(1) Biomedical Center, Faculty of Medicine in Pilsen, Charles University (2) Department of Anatomy,
Faculty of Medicine in Pilsen, Charles University
State-of-the-Art: Pigs are widely used in preclinical studies for developing cardiovascular devices
due to their anatomical similarities to humans. However, the pig aorta exhibits significant
anatomical variability, necessitating individualised preoperative planning.
Objective: The lack of detailed morphometric data on the porcine aorta and its branches can
lead to mismatches in device sizing, potentially causing complications or fatalities in experimental
settings. For this purpose, we are developing a freely available library of pig aorta data for further use.
Material and Methods: CT-angiography scans of 26 Prestice Black-Pied piglets were acquired arterial and venous phase images were captured from the animals involved in the biomedical research. The image segmentation was done in the 3D Slicer software (slicer.org). The main visceral branches of the abdominal aorta were visualised and further evaluated – the coeliac artery with its main branches, and the superior mesenteric artery.
Results & Discussion: Acquired data will then be used to train artificial neural networks with the U-Net architecture to develop an automatic pig-specific vessel segmentation method. We also aim to map the Presticke Black Pied breed vascular tree and its variability to gain unique data for training and further research optimisation.
Conclusion: The results so far show significant potential for using the unique database of already
obtained data from examined animals in our Biomedical Center. They will be used to train
Artificial Neural Networks with the U-Net architecture.
Funding: Charles University Grant Agency (GAUK) and Specific Research (SVV).
Study program: Master´s degree – General Medicine | Year of study: 2
ID: 1141

Authors: Nikola Hejhalová (1), Lenka Vaňková (1), Jiří Cendelín (2), Veronika Hátlová (3), Markéta Debnarová (2), Lenka Hecová (2), Pavel Klein (4), Štěpán Rusňák (2), Pavel Studený (3)
Supervisor: Věra Křížková (1)
(1) Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University (2) Department of Ophthmalmology Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen (3) Department of Ophthalmology, University Hospital Královské Vinohrady and Third Medical Faculty, Charles University(4) Laboratory of Preclinical Studies, Biomedical Center, Faculty of Medicine in Pilsen, Charles University
State-of-the-Art: In cataract surgery, extracapsular extraction of the lens and implantation of an artificial one into the preserved part of the original lens capsule is the standard method. If this is not possible, a lens requiring fixation is implanted. With advancing surgical techniques, various methods of scleral fixation have been developed. One option is the fixation of the artificial lens with sutures to the sclera. This procedure and the materials used are well established in ophthalmology. Despite its routine use, a detailed comparative analysis of tissue response remains lacking.
Objective: The study aimed to analyze the scleral tissue response to different suture materials used for scleral suspension, comparing them both with each other and over different time intervals.
Material and Methods: A total of 18 adult rabbits were included in the experiment. All underwent the same procedure with scleral suspension, with the second eye serving as the control. Three different materials were used. The rabbits were divided into groups with different survival times after surgery – 1, 3, or 6 months. The integration of sutures into the sclera was assessed mechanically, followed by a histological examination of the samples. After standard histological processing, tissue samples were stained using hematoxylin-eosin for basic evaluation of tissue response, including inflammatory infiltration and the depth of inflammation. For evaluation of collagen formation and composition, picrosirius red staining and polarized microscopy were used. Samples were analyzed using stereological software.
Results & Discussion: Histological analysis confirmed the presence of inflammation in all collected samples. The intensity and depth of inflammation varied both among different suture materials and across different time intervals. Collagen formation increased with prolonged suture retention in ocular tissue.
Conclusion: In the rabbit model, varying levels of inflammation and collagen production were observed across the study groups. Both collagen production and inflammation are crucial clinical factors that may guide the selection of the optimal suture material.
Funding: Charles University, Project No. SVV 260 773 and the Cooperatio program MED/DIAG and Surgical Disciplines supported this work.
Study program: Master´s degree – General Medicine | Year of study: 6
ID: 1089

Hemodynamic Evaluation and Fluid Response Observation through Respiratory Man euvers (HERO)

Authors: Natálie Desenská (1)
Supervisor: Olga Smékalová (1,2)
(1) Department of Anaesthesiology and Intensive Care, Faculty of Medicine in Pilsen, Charles
University and University Hospital, Pilsen (2) Simulation Center, Faculty of Medicine in Pilsen,
Charles University
State-of-the-Art: In managing critically ill patients, initial fluid administration aims to increase
stroke volume and cardiac output. Fluid responsiveness is commonly assessed using dynamic
indices, with the Passive Leg Raising (PLR) test being a validated, reversible method. However,
PLR is contraindicated in patients with unstable spine or pelvic fractures or with trauma brain
injury. Respiratory maneuvers, which alter intrathoracic pressure to develop preload changes,
offer a potential alternative, especially in spontaneously breathing patients.
Objective: This study aims to evaluate respiratory maneuvers as alternatives to the fluid challenge
and PLR test for assessing fluid responsiveness in spontaneously breathing patients when standard methods are contraindicated.
Material and Methods: After informed consent, healthy volunteers underwent non-invasive
hemodynamic monitoring (Acumen IQ cuff, HemoSphere monitor (Edwards Lifesciences)). Respiratory
maneuvers (maximal inspiration/expiration, Valsalva, Müller) were performed for 20 seconds each, with 2-minute rests in between. Subsequently, a PLR test over 1 minute and a fluid challenge with 500 mL balanced crystalloid over 10 minutes were performed. A positive fluid responsiveness test was defined as a >10% increase in cardiac index (CI) or stroke volume index (SVI). Echocardiography assessing the cardiac function and intravascular volume status complemented baseline and final assessments.
Results & Discussion: Among 11 subjects, 4 responded to the fluid challenge by both CI and
SVI (RR), 3 by CI only (R-CI), 1 by SVI only (R-SVI), 3 subjects were non-responders (NR). In RR,
maximal inspiration elicited a positive response in CI or SVI in 1 subject, maximal exspiration in 2
subjects, Valsalva in 2, and Müller in 2. In R-CI, only Müller elicited a response in 1 subject. Three
RR subjects responded to at least two maneuvers. In NR, Müller and Valsalva were positive in 4
and 1 subjects, on the contrary. These preliminary data suggest that specific respiratory maneuvers—
especially Müller and Valsalva—may increase preload with a response, but false positives
in NR raise concerns about specificity.
Conclusion: Preliminary findings support the feasibility of using respiratory maneuvers to assess
fluid responsiveness in spontaneously breathing patients when standard tests are contraindicated.
Multiple maneuvers may be required to enhance diagnostic accuracy. Further data are ongoing.
Funding: The study was supported by the COOPERATIO (Intensive Care Medicine) institutional
programme of Charles University.
Study program: Master´s degree – General Medicine | Year of study: 6
ID: 1126