Radiation therapy manages pancreatic cancer in various settings; however, the proximity of gastrointestinal (GI) luminal organs at risk (OARs) poses challenges to conventional radiation therapy. Proton beam therapy (PBT) may reduce toxicities compared to photon therapy. This consensus statement summarizes PBT's safe and optimal delivery for pancreatic tumors. Our group has specific expertise using PBT for GI indications and has developed expert recommendations for treating pancreatic tumors with PBT. Computed tomography (CT) simulation: Patients should be simulated supine (arms above head) with custom upper body immobilization. For stomach/duodenum filling consistency, patients should restrict oral intake within 3 hours before simulation/treatments. Fiducial markers may be implanted for image guidance; however, their design and composition require scrutiny. The reconstruction field-of-view should encompass all immobilization devices at the target level (CT slice thickness 2-3 mm). Four-dimensional CT should quantify respiratory motion and guide motion mitigation. Respiratory gating is recommended when motion affects OAR sparing or reduces target coverage. Treatment planning: Beam-angle selection factors include priority OAR-dose minimization, water-equivalent-thickness stability along the beam path, and enhanced relative biological effect consideration due to the increased linear energy transfer at the proton beam end-of-range. Posterior and right-lateral beam angles that avoid traversing GI luminal structures are preferred (minimizing dosimetric impacts of variable anatomies). Pencil beam scanning techniques should use robust optimization. Single-field optimization is preferable to increase robustness, but if OAR constraints cannot be met, multifield optimization may be used. Treatment delivery: Volumetric image guidance should be used daily. CT scans should be acquired ad hoc as necessary (at minimum every other week) to assess the dosimetric impacts of anatomy changes. Adaptive replanning should be performed as required. Our group has developed recommendations for delivering PBT to safely and effectively manage pancreatic tumors.
- MeSH
- celková dávka radioterapie MeSH
- čtyřrozměrná počítačová tomografie MeSH
- dýchání MeSH
- imobilizace metody MeSH
- konsensus MeSH
- kritické orgány * diagnostické zobrazování účinky záření MeSH
- lidé MeSH
- nádory slinivky břišní * radioterapie diagnostické zobrazování MeSH
- plánování radioterapie pomocí počítače metody MeSH
- pohyb vnitřních orgánů MeSH
- pohyb MeSH
- protonová terapie * metody škodlivé účinky normy MeSH
- radiační poranění prevence a kontrola MeSH
- radioterapie řízená obrazem metody MeSH
- žaludek diagnostické zobrazování MeSH
- zaměřovací značky pro radioterapii MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
OBJECTIVES: Patients are the most common source of violence against EMS personnel. This study aims at elucidating specific clinical features in patients with mental alteration and aggressive behaviour increasing risk of violence. MATERIAL AND METHODS: This consecutive cross-sectional retrospective study analysed consecutive patients treated for prespecified list of primary diagnoses by one EMS provider in the Czech Republic between 1 January 2021 and 31 December 2023. The effect of individual features of medical history and present symptoms on the occurrence of violence, need for the Police assistance and use of restraints was evaluated, using linear regression model. RESULTS: 410 patients were evaluated. Verbal and brachial violence was present in 21.5 and 12.9 %, respectively. Police assistance was needed in 48.3 %, restraints were used in 4.6 %. The most significant predictor for violence, need for Police or restraints was agitation (OR 7.02, CI 4.14 - 11.90; OR 2.60, CI 1.60 - 4.24, OR 11.02, CI 3.49 - 34.80 respectively). Other predictors of violence included history of acute psychotic attacks and psychotic disorders, or outpatient psychiatry care. Among other predictors for Police assistance was presence of delusions, paranoia and history of outpatient psychiatry care. CONCLUSION: Prehospital care for patients with mental status alteration and aggressive behaviour is complex. Some clinical features seem to increase the risk of violence. Future research in the evaluation of agitated and violent patients is warranted to find strategies of risk mitigation for EMS personnel.
- MeSH
- agrese * psychologie MeSH
- dospělí MeSH
- duševní poruchy epidemiologie terapie MeSH
- fyzické omezení statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- násilí statistika a číselné údaje psychologie MeSH
- policie MeSH
- průřezové studie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- urgentní zdravotnické služby * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Abnormal hip bone morphologies are associated with various diseases of the hip joint. Weight bearing, especially during growth, may be important to achieve normal acetabulum development. This study aimed to investigate whether hip bone morphologies were affected by hindlimb suspension (HS) in 4 week-old rats. In HS groups, tail suspension was applied for 0, 2, 4, and 8 weeks. Age-matched rats were used as controls. The complex of hip bones with lumbar and sacral vertebrae were assessed based on morphological indexes using three-dimensional reconstructed images from X-ray computed tomography. Acetabular widths (measured from cranial to caudal) unchanged and depths became larger in both groups with age. Acetabular lengths (from the ventral side to the dorsal side) became larger in control groups but unchanged in HS groups with age. In HS groups, acetabular width, length, and depths were smaller than the control groups at 4 and/or 8 weeks. Acetabular versions became enlarged (rotated inwards) with age in both groups, although this was particularly pronounced in HS groups. Histologically, triradiate cartilage layers in the acetabulum were thinner with age and almost disappeared at 8 weeks in both groups. However, HS decreased Safranin O staining and prolonged the presence of hypertrophic chondrocyte indicating alterations in the chondral ossification processes. Iliac wing angles remained unchanged and anterior superior iliac crest (ASIC) distances increased with age in controls. In contrast, HS groups showed narrowed iliac wing angles with small ASIC distances. These results suggest that reduced mechanical loading during growth can interfere with hip joint formation. Keywords Hindlimb suspension, Hip joint, Acetabular morphology, Triradiate cartilage.
We hypothesized that sympathetic hyperactivity and parasympathetic insuficiency in spontaneously hypertensive rats (SHR) underlie their exaggerated cardiovascular response to acute stress and impaired adaptation to repeated restraint stress exposure compared to Wistar-Kyoto rats (WKY). Cardiovascular responses to single (120 min) or repeated (daily 120 min for 1 week) restraint were measured by radiotelemetry and autonomic balance was evaluated by power spectral analysis of systolic blood pressure variability (SBPV) and heart rate variability (HRV). Baroreflex sensitivity (BRS) was measured by the pharmacological Oxford technique. Stress-induced pressor response and vascular sympathetic activity (low-frequency component of SBPV) were enhanced in SHR subjected to single restraint compared to WKY, whereas stress-induced tachycardia was similar in both strains. SHR exhibited attenuated cardiac parasympathetic activity (high-frequency component of HRV) and blunted BRS compared to WKY. Repeated restraint did not affect the stress-induced increase in blood pressure. However, cardiovascular response during the post-stress recovery period of the 7th restraint was reduced in both strains. The repeatedly restrained SHR showed lower basal heart rate during the dark (active) phase and slightly decreased basal blood pressure during the light phase compared to stress-naive SHR. SHR subjected to repeated restraint also exhibited attenuated stress-induced tachycardia, augmented cardiac parasympathetic activity, attenuated vascular sympathetic activity and improved BRS during the last seventh restraint compared to single-stressed SHR. Thus, SHR exhibited enhanced cardiovascular and sympathetic responsiveness to novel stressor exposure (single restraint) compared to WKY. Unexpectedly, the adaptation of cardiovascular and autonomic responses to repeated restraint was more effective in SHR.
- MeSH
- autonomní nervový systém * patofyziologie MeSH
- baroreflex * fyziologie MeSH
- fyzické omezení * MeSH
- fyziologická adaptace * fyziologie MeSH
- hypertenze * patofyziologie MeSH
- krevní tlak * fyziologie MeSH
- krysa rodu rattus MeSH
- potkani inbrední SHR * MeSH
- potkani inbrední WKY * MeSH
- psychický stres patofyziologie MeSH
- srdeční frekvence * fyziologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Obezita predstavuje v súčasnosti celosvetovú pandémiu. Počet obéznych pacientov narastá aj v zdravotníckych zariadeniach, kde stoja pred ošetrujúcim personálom rôzne výzvy a prekážky, ktoré je potrebné pri ošetrovaní obéznych pacientov zvládnuť. Príspevok akcentuje pozornosť na najvýznamnejšie limitácie a riziká ošetrovania obéznych v zdravotníckych zariadeniach z pohľadu sestier z praxe.
Obesity is currently a global pandemic. The number of obese patients is also increasing in healthcare facilities, where nursing staff face various challenges and obstacles that need to be overcome when treating obese patients. The paper emphasizes attention to the most significant limitations of the treatment of obese people in healthcare facilities from the perspective
- MeSH
- antikoagulancia terapeutické užití MeSH
- dehydratace ošetřování terapie MeSH
- delirium ošetřování terapie MeSH
- geriatrické ošetřovatelství MeSH
- imobilizace MeSH
- nádorová bolest ošetřování terapie MeSH
- nádory MeSH
- ošetřovatelská péče o pacienty v kritickém stavu MeSH
- oxygenoterapie MeSH
- podvýživa ošetřování terapie MeSH
- polohování pacienta MeSH
- poruchy močení MeSH
- rehabilitace MeSH
- senioři MeSH
- Check Tag
- senioři MeSH
- MeSH
- dítě MeSH
- fixace fraktury metody MeSH
- fraktury kostí * terapie MeSH
- imobilizace metody MeSH
- konzervativní terapie metody MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- trakce metody MeSH
- uzavřená repozice fraktury metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- přehledy MeSH
Úvod: Chronická bolesť sa stala bežným problémom v rámci primárnej starostlivosti a môže negatívne ovplyvniť životy pacientov. Cieľ: Zhodnotiť a preskúmať vplyv chronickej bolesti dolnej časti chrbtice na kvalitu života pacientov (QoL) pomocou kvantitatív- nych a kvalitatívnych údajov. Metodika: Bol použitý štandardizovaný dotazník kvality života SF-36. Do súboru bolo zaradených 161 respondentov od 18 rokov veku, s chronickou bolesťou v dolnej časti chrbta, v trvaní minimálne 6 mesiacov s diagnózou lumboischiadický radikulárny syndróm. Priemerný vek respondentov bol 49,8 rokov. Výsledky: Najnižšie priemerné skóre celého súboru bolo dosiahnuté v doménach obmedzenie fyzickej aktivity a v doméne zmena zdravia. Hodnoty jednotlivých domén sú medzi pohlaviami porovnateľné. Najvýraznejší rozdiel bol zaznamenaný v doméne fy- zická aktivita, ktorú ženy hodnotili vyššie (Ž; d = 62,9; M; d = 52,3). Boli zaznamenané významné korelácie hodnotenia všetkých domén s vekom (p < 0,001), s výnimkou domény VT vitalita a PZ celkové psychické zdravie. Signifikancia bola dokázaná aj medzi dĺžkou praxe (zamestnania) a obmedzením fyzickej aktivity, a telesnou bolesťou a súhrnom fyzických komponentov, ktoré sa dĺžkou praxe zhoršujú. So zamestnaním koreluje hodnotenie všetkých domén. Bol dokázaný silný štatistický vzťah medzi súhr- nom fyzických a psychických komponentov. Záver: Z dosiahnutých výsledkov vyplýva, že kvalita života pacientov s chronickou bolesťou dolnej časti chrbta sa vekom význam- ne štatisticky znižuje. Dĺžkou praxe sa prehlbuje obmedzenie fyzickej aktivity, zhoršuje sa telesná bolesť, ale aj súhrn fyzických komponentov.
Introduction: Chronic pain has become a common problem in primary care and can negatively impact the lives of patients. Objective: To evaluate and investigate the impact of chronic lower back pain on patients' quality of life (QoL) using quantitative and qualitative data. Methods: A standardized SF-36 quality of life questionnaire was used. The group included 161 respondents aged 18 and over, with chronic lower back pain, lasting at least 6 months, with a diagnosis of lumbosciatica radicular syndrome. The average age of the respondents was 49.8 years. Results: The RP (Role Physical) and DZ (change in health) had the lowest average score. The values of the individual domains of the sexes are comparable. The most significant difference is in the Physical Functioning domain, which was rated higher by women (W; d = 62.9; M; d = 52.3). All domains have significant correlations with age (p < 0.001), with the exception of VT - vitality, and MH - mental health. The statistical significance was also determined between Seniority (Employment) and RP - physical restrictions, Bodily Pain and Physical Component Summary. They worsen with seniority. All domain scores correlate with employment. A strong statistical relationship between Physical Component Summary and Mental Component Summary was demonstrated. Conclusions: The results show that the quality of life of patients with chronic lower back pain decreases significantly with age. Seniority deepens physical restrictions (Role Physical) and worsens Bodily Pain as well as Physical Component Summary.
