BACKGROUND: The diagnostic accuracy of prostate magnetic resonance imaging (MRI) is highly dependent on image quality. Although the effects of spasmolytics and rectal preparation have been previously studied, the findings remain inconsistent and fail to address other critical modifiable factors. This study aimed to evaluate the impact of various modifiable factors on prostate MRI image quality and their subsequent influence on Prostate Imaging Reporting and Data System (PI-RADS) scoring. METHODS: Fifty-six consecutive patients who underwent 3T multiparametric MRI (mpMRI) with the administration of hyoscine butylbromide (HB+) and at least one 3T mpMRI without HB (HB-) ≤3 years earlier were retrospectively evaluated. Two radiologists performed morphometry of the prostate, bladder, rectum, and abdomen and evaluated image quality, artifacts, and motion on a five-point scale and T2 and diffusion-weighted imaging (DWI) PI-RADS v2.1 scores. The influence of HB, rectum and bladder distension, breathing motion, and examination hour were analyzed. RESULTS: The sharpness and overall image quality of T2 images were significantly better in HB+ compared to HB- (P=0.0047 and P=0.013). T2 motion artifacts were reduced earlier in the day (ρ=0.32, P=0.017). DWI susceptibility artifact correlated with patient diameter (ρ=0.40, P=0.002), but not with rectum diameter (ρ=0.09, P=0.51) or gas content (ρ=0.13, P=0.33). Examinations later in the day were associated with increased motion artifacts on T2 [hazard ratio (HR) =1.36]. T2 and DWI scores were influenced by bladder volume, breathing motion, and rectal air, but not by HB. Breathing motion negatively impacted overall image quality (HR =1.24), and DWI susceptibility artifacts (HR =1.22). CONCLUSIONS: HB administration, daytime, and breathing motion have significant influence on image quality of prostate MRI. The gas content of the rectum influences T2 image quality and T2 scores. Bladder filling is associated with reduced breathing motion, subsequently affecting DWI scores.

• Publikační typ
• časopisecké články MeSH

Pediatric and perinatal palliative care development has received particular attention in the Czech Republic in recent years. As part of the cooperation project of clinics in developing comprehensive care in the perinatal period, this area has been the focus of attention in the Perinatology Intensive Care Centre at the General University Hospital in Prague. In addition to broad educational activities, a questionnaire study with two parts – semi-quantitative and qualitative – was conducted to describe the respondents' perceptions of the importance of perinatal palliative care topics and assess their practice in providing care. Respondents to the questionnaire PRIMA were from various professions and leadership roles in different departments and across specialties in the perinatology center.

Rozvoji dětské a perinatální paliativní péče je v České republice věnována v posledních letech zvláštní pozornost. V rámci projektu spolupráce klinik při rozvoji komplexní péče v perinatálním období se na tuto oblast zaměřuje pozornost i v perinatologickém centru intenzivní péče ve Všeobecné fakultní nemocnici v Praze. Kromě širokých edukačních aktivit proběhla také dotazníková studie zaměřená na vnímání respondentů ohledně důležitosti témat perinatální paliativní péče a posouzení vlastní praxe při poskytování péče. Respondenty semikvantitativní a kvalitativní dotazníkové studie s použitím dotazníku PRIMA byli zástupci různých profesí ve vedoucích rolích na jednotlivých odděleních a napříč odbornostmi perinatologického centra.

BACKGROUND: Deep-learning-based reconstruction (DLR) improves the quality of magnetic resonance (MR) images which allows faster acquisitions. The aim of this study was to compare the image quality of standard and accelerated T2 weighted turbo-spin-echo (TSE) images of the prostate reconstructed with and without DLR and to find associations between perceived image quality and calculated image characteristics. METHODS: In a cohort of 47 prospectively enrolled consecutive patients referred for bi-parametric prostate magnetic resonance imaging (MRI), two T2-TSE acquisitions in the transverse plane were acquired on a 3T scanner-a standard T2-TSE sequence and a short sequence accelerated by a factor of two using compressed sensing (CS). The images were reconstructed with and without DLR in super-resolution mode. The image quality was rated in six domains. Signal-to-noise ratio (SNR), and image sharpness were measured. RESULTS: The mean acquisition time was 281±23 s for the standard and 140±12 s for the short acquisition (P<0.0001). DLR images had higher sharpness compared to non-DLR (P<0.001). Short and short-DLR had lower SNR than the standard and standard-DLR (P<0.001). The perceived image quality of short-DLR was rated better in all categories compared to the standard sequence (P<0.001 to P=0.004). All domains of subjective evaluation were correlated with measured image sharpness (P<0.001). CONCLUSIONS: T2-TSE acquisition of the prostate accelerated using CS combined with DLR reconstruction provides images with increased sharpness that have a superior quality as perceived by human readers compared to standard T2-TSE. The perceived image quality is correlated with measured image contrast.

• Publikační typ
• časopisecké články MeSH

Při poskytování perinatální paliativní péče je nezbytná spolupráce mnohých odborností. Vnímání a porozumění možnostem a současným nástrojům specializované paliativní péče se mezi odbornostmi i jednotlivými profesionály liší. Potřebný validovaný dotazník, který by vnímání mapoval, v českém i v mezinárodním prostředí dosud chybí. Předkládáme proto dotazník pro expertní vícedoménové hodnocení perinatální paliativní péče (Palliative peRInatal Multidomain Assessment [PRIMA]). Dotazník prošel dvoukolovou externí validací a hodnocením vnitřní konzistence (Cronbachovo α pro celý dotazník 0.799 [95% konfidenční interval 0.550–0.878], pro podotázky na aktuální stav 0.767 [0.544–0.877] a podotázky na ideální stav 0.867 [0.763–0.916]).

Perinatal palliative care is based on the cooperation of multiple workers with multiple areas of expertise. Perceptions and understanding of the possibilities and current tools of specialised palliative care vary between specialties and between professionals. The necessary validated questionnaire, which would map the perception of individual health professionals in the Czech and international environment, is still missing. The Palliative peRInatal Multidomain Assessment (PRIMA) questionnaire is presented and externally validated in a two-round process. Internal consistency is calculated (Cronbach’s α for the whole questionnaire, for the subset of items about the actual state, and the subset of items about the ideal state is 0.799 [95% confidence interval 0.550–0.878], 0.767 [0.544–0.877], and 0.867 [0.763–0.916] respectively).

• Klíčová slova
• perinatální paliativní péče,
• MeSH
• lidé MeSH
• nemoci plodu MeSH
• novorozenec MeSH
• paliativní péče * MeSH
• perinatální péče * MeSH
• perinatální smrt MeSH
• průzkumy a dotazníky MeSH
• těhotenství MeSH
• vrozené vady MeSH
• zdravotní péče - kvalita, dosažitelnost a hodnocení MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH

OBJECTIVES: To quantify extraprostatic findings (EPFs) on prostate MRI, estimate the proportion of reported and unreported EPFs, assess their clinical importance, and propose standardized reporting of EPFs. MATERIALS AND METHODS: Prostate 3-T MRI studies, reports, and clinical data from 623 patients (age 67.9 ± 8.2 years) were retrospectively analyzed and re-evaluated for the presence of EPFs and their clinical significance: E1-no finding or findings that have no clinical significance; E2-potentially significant findings; and E3-significant findings. RESULTS: Secondary reading identified 1236 EPFs in 593 patients (1.98 ± 1.13 EPFs per patient, no EPFs in 30 patients), from which 468 (37.8%) were mentioned in the original report. The most common findings included diverticulosis (44% of patients), hydrocele (34%), inguinal fat hernia (16%), and bladder wall trabecular hypertrophy (15%). There were 80 (6.5%) E2 EPFs and 30 (2.4%) E3 EPFs. From E3 EPFs, 10 (33%) were not originally reported. A workup was suggested in 35 (52%) of the 67 originally reported E2 and E3 findings with follow-up and performed in 20 (30%). Fourteen (21%) EPFs in 11 patients influenced their management. Four experienced radiologists originally reported 1.8 to 2.5 findings per patient (p < 0.0001). CONCLUSIONS: EPFs on prostate MRI are frequent, but only 2.4% are clinically significant (E3), and 33% of these are not reported. Only 30% of E2 and E3 findings are further explored, and 21% influence patient management. We suggest that an "E" category should be attached to the PI-RADS system to identify the presence of EPFs that require further workup. CRITICAL RELEVANCE STATEMENT: Extraprostatic findings on prostate MRI are frequent, but only 2.4% are clinically significant (E3), and 33% of these are not reported. We advocate standardized reporting of extraprostatic findings indicating their clinical significance. KEY POINTS: • Extraprostatic findings on prostate MRI are frequent with an average of two findings per patient. • 2.4% of extraprostatic findings are significant, and 33% of these are not reported. • There is a significant variability among experienced radiologists in reporting extraprostatic findings.

• Publikační typ
• časopisecké články MeSH

Úvod: Antibiotická profylaxe představuje dle mezinárodních doporučení nedílnou součást transrektální biopsie prostaty. Nejčastěji užívanými antibiotiky jsou ciprofloxacin a kotrimoxazol. Výskyt rezistence na oba preparáty má však vzestupný trend. Cílem naší práce je zhodnocení mikrobiálního profilu z rektálního stěru a určení citlivosti bakteriálních kmenů u pacientů indikovaných k fúzní biopsii prostaty (FBP). Materiál a metody: V období od 03/2019 do 05/2020 jsme vyšetřili celkem 192 pacientů. Profylakticky byl nejčastěji podán kotrimoxazol 960 mg p. o. po 12 hodinách v celkem třech dávkách počínaje ránem v den biopsie. Při alergii jsme doporučili ciprofloxacin 750 mg p. o. ve stejném režimu. Rektální stěr jsme provedli těsně před výkonem. Bakteriální kmeny byly kultivovány na běžných půdách, citlivost jsme stanovili kvalitativně difuzní diskovou metodou. Zaznamenali jsme nejvýše tři kmeny a v případě rezistence pak všechna hodnocená antibiotika. Prospektivně jsme sledovali výskyt septické reakce, charakterizované celkovou alterací stavu, teplotou nad 38 °C a bolestivým nálezem per rektum s nutností hospitalizace do sedmi dnů po provedení FBP. Výsledky: U 170 (88,5 %) pacientů jsme zjistili celkem 266 bakteriálních kmenů. Nejčastěji kultivovaným kmenem byla Escherichia coli s citlivostí na všechna antibiotika (45,8 % pacientů). Rezistence Escherichia coli na potencované aminopeniciliny byla zjištěna u 22 % kmenů. Zvlášť sledovanou rezistenci na kotrimoxazol, respektive ciprofloxacin jsme zaznamenali celkově u 19 %, respektive 22 % kmenů. Vícečetná rezistence (na tři a více antibiotik) byla popsána u 27 kmenů. Septická komplikace nastala celkem u tří (1,6 %) pacientů, které prezentujeme v krátkých kazuistikách. Závěr: Naše výsledky ukazují obdobný výskyt patogenů rezistentních na obě běžně užívaná antibiotika. I přes relativně vysoký výskyt rezistence zůstává počet klinických komplikací nízký.

Introduction: Antibiotic prophylaxis is, according to international recommendations, an integral part of transrectal prostate biopsy. The most used antibiotics are ciprofloxacin and cotrimoxazole. However, the incidence of resistance to both substances has an upward trend. The aim of our work was to evaluate the microbial profile from a rectal swab and to determine the sensitivity of bacterial strains in patients indicated for multiparametric magnetic resonance imaging-guided prostate biopsy. Material and methods: In the period from 03/2019 to 05/2020, we examined a total of 192 patients. Prophylactically, cotrimoxazole 960 mg p. o. every 12 hours in a total of three doses starting in the morning on the day of the biopsy was most administered. In case of allergy, we recommended ciprofloxacin 750 mg p. o. in the same regime. We performed a rectal swab just before the procedure. Bacterial strains were cultured on common soils, sensitivity was determined qualitatively by the diffusion disk method. We recorded a maximum of three strains and, in the case of resistance, all evaluated antibiotics. We prospectively monitored the occurrence of a septic reaction, characterized by a general alteration of the condition, a temperature above 38 °C and a painful per rectum finding requiring hospitalization within seven days after the procedure. Results: A total of 266 bacterial strains were found in a total of 170 (88.5 %) patients. The most frequently cultured strain was Escherichia coli with sensitivity to all antibiotics (45.8 % of all patients). Most often, we described Escherichia coli resistance to potentiated aminopenicillin (22 % of strains). Resistance to cotrimoxazole and ciprofloxacin, respectively, was observed in 19 % and 22 % strains, respectively. Resistance to three or more antibiotics has been described in 27 strains. Septic complication occurred in a total of three (1.6 %) patients, we present those in short case reports. Conclusion: Our results show a similar incidence of pathogens resistant to both commonly used antibiotics. Despite the relatively high incidence of resistance, the number of clinical complications remains low.

• Klíčová slova
• transrektální biopsie prostaty,
• MeSH
• antibiotická profylaxe * metody   MeSH
• biopsie * metody   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• nádory prostaty * diagnóza   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH

OBJECTIVE: The aim of the study was to test the potential role of breast arterial calcification (BAC) in the prediction of coronary artery disease (CAD) in women. The criterion standard for CAD diagnostics was coronary angiography. METHODS: This retrospective study enrolled 163 consecutive women, who underwent digital mammography and coronary angiography in our hospital. We assessed the presence and severity of BAC, and tested whether the presence and/or extent of BAC could be a predictor for CAD, quantified by Gensini score. RESULTS: BAC was presented in 34 patients (21%). Neither the presence of CAD (17 patients, 50%, vs 55 42.6%, P = 0.44), nor the Gensini score (20.5 ± 29.7 vs 15.4 ± 24.1, P = 0.3) differed significantly between BAC-present and BAC-absent patients.A finding of triple-vessel disease, however, more frequently occurred in the BAC-present (seven patients, 20.6%) than in the BAC-absent (nine patients, 7%) group, odds ratio (OR) 3.1, 95% CI 1-9.5, P = 0.049. The presence of BAC did not significantly increase the odds for the presence of CAD (OR = 1.29, P = 0.54). Among the subgroup of patients with CAD, BAC presence was associated with triple vessel disease (OR = 3.34, P = 0.049). CONCLUSIONS: We did not confirm BAC as a predictor of CAD. However, BAC showed association with more severe forms of coronary atherosclerosis (triple vessel disease).

• MeSH
• časná detekce nádoru MeSH
• koronární angiografie MeSH
• lidé MeSH
• mamografie MeSH
• nádory prsu * diagnostické zobrazování   MeSH
• nemoci koronárních tepen * diagnostické zobrazování   MeSH
• prediktivní hodnota testů MeSH
• prsy diagnostické zobrazování   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• vaskulární kalcifikace * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

SOX2 is essential for maintaining neurosensory stem cell properties, although its involvement in the early neurosensory development of cranial placodes remains unclear. To address this, we used Foxg1-Cre to conditionally delete Sox2 during eye, ear, and olfactory placode development. Foxg1-Cre mediated early deletion of Sox2 eradicates all olfactory placode development, and disrupts retinal development and invagination of the lens placode. In contrast to the lens and olfactory placodes, the ear placode invaginates and delaminates NEUROD1 positive neurons. Furthermore, we show that SOX2 is not necessary for early ear neurogenesis, since the early inner ear ganglion is formed with near normal central projections to the hindbrain and peripheral projections to the undifferentiated sensory epithelia of E11.5-12.5 ears. However, later stages of ear neurosensory development, in particular, the late forming auditory system, critically depend on the presence of SOX2. Our data establish distinct differences for SOX2 requirements among placodal sensory organs with similarities between olfactory and lens but not ear placode development, consistent with the unique neurosensory development and molecular properties of the ear.

• MeSH
• apoptóza MeSH
• myši knockoutované MeSH
• myši MeSH
• neurogeneze * MeSH
• nosní sliznice embryologie   metabolismus   MeSH
• oční čočka embryologie   metabolismus   MeSH
• transkripční faktory SOXB1 genetika   metabolismus   MeSH
• vnitřní ucho cytologie   embryologie   metabolismus   MeSH
• zvířata MeSH
• Check Tag
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Hearing depends on extracting frequency, intensity, and temporal properties from sound to generate an auditory map for acoustical signal processing. How physiology intersects with molecular specification to fine tune the developing properties of the auditory system that enable these aspects remains unclear. We made a novel conditional deletion model that eliminates the transcription factor NEUROD1 exclusively in the ear. These mice (both sexes) develop a truncated frequency range with no neuroanatomically recognizable mapping of spiral ganglion neurons onto distinct locations in the cochlea nor a cochleotopic map presenting topographically discrete projections to the cochlear nuclei. The disorganized primary cochleotopic map alters tuning properties of the inferior colliculus units, which display abnormal frequency, intensity, and temporal sound coding. At the behavioral level, animals show alterations in the acoustic startle response, consistent with altered neuroanatomical and physiological properties. We demonstrate that absence of the primary afferent topology during embryonic development leads to dysfunctional tonotopy of the auditory system. Such effects have never been investigated in other sensory systems because of the lack of comparable single gene mutation models.SIGNIFICANCE STATEMENT All sensory systems form a topographical map of neuronal projections from peripheral sensory organs to the brain. Neuronal projections in the auditory pathway are cochleotopically organized, providing a tonotopic map of sound frequencies. Primary sensory maps typically arise by molecular cues, requiring physiological refinements. Past work has demonstrated physiologic plasticity in many senses without ever molecularly undoing the specific mapping of an entire primary sensory projection. We genetically manipulated primary auditory neurons to generate a scrambled cochleotopic projection. Eliminating tonotopic representation to auditory nuclei demonstrates the inability of physiological processes to restore a tonotopic presentation of sound in the midbrain. Our data provide the first insights into the limits of physiology-mediated brainstem plasticity during the development of the auditory system.

• MeSH
• chování zvířat fyziologie   MeSH
• colliculus inferior anatomie a histologie   fyziologie   MeSH
• ganglion spirale cytologie   fyziologie   MeSH
• mapování mozku MeSH
• mezencefalon embryologie   fyziologie   MeSH
• myši knockoutované MeSH
• myši MeSH
• nucleus cochlearis anatomie a histologie   fyziologie   MeSH
• sluch fyziologie   MeSH
• sluchová percepce genetika   fyziologie   MeSH
• těhotenství MeSH
• transkripční faktory bHLH genetika   fyziologie   MeSH
• úleková reakce genetika   fyziologie   MeSH
• vestibulární aparát anatomie a histologie   fyziologie   MeSH
• vnímání výšky zvuku fyziologie   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• myši MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

OBJECTIVES: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. METHODS: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). RESULTS: Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). CONCLUSION: This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

• MeSH
• adrenokortikální karcinom diagnostické zobrazování   MeSH
• dospělí MeSH
• feochromocytom diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metastázy nádorů MeSH
• mladý dospělý MeSH
• nádory nadledvin diagnostické zobrazování   MeSH
• regresní analýza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• statistické modely MeSH
• tomografie spirální počítačová MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH