INTRODUCTION AND HYPOTHESIS: The aim of this prospective, open-label, multicenter, noncomparative study was to evaluate the efficacy and safety of peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) using the URIS® neuromodulation system as a home treatment for refractory overactive bladder (OAB). METHODS: The patients were treated with daily peroneal eTNM® for 30 min over a 6-week period. The primary endpoint was defined as the proportion of responders, i.e., participants with ≥ 50% reduction in the average daily sum of severe urgency episodes (defined as "I could not postpone voiding but had to rush to the toilet in order not to wet myself") and urgency incontinence episodes. In addition, bladder diary variables, symptom severity (OAB V8 questionnaire), treatment satisfaction (visual analog scale), and pain perception (visual analog scale) were evaluated at baseline (BL), at week 4 (W4), and at the end of treatment (EoT). Safety evaluations included monitoring of the incidence and severity of adverse events (AEs). Changes in time were analyzed using the nonparametric one-way ANOVA Friedman test for categorical variables and the Wilcoxon rank-sum test for the noncategorical variables. RESULTS: In total, 40 subjects were screened and 29 were included in the full analysis set. The proportion of responders was 86% at W4 and 79% at EoT. There was a significant reduction in frequency (p<0.001), number of severe urgency episodes (p< 0.001), number of urgency incontinence episodes (p=0.001), and number of nocturia episodes (p=0.002). There was a significant improvement in the OAB V8 score and treatment satisfaction (both p<0.001). Two mild treatment-related AEs were recorded. Both patients recovered without sequelae and completed the study. CONCLUSIONS: Peroneal eTNM® proved to be a highly effective and safe method for the home treatment of OAB, providing a therapeutic response in approximately 80% of patients.

• MeSH
• hyperaktivní močový měchýř * farmakoterapie   MeSH
• inkontinence moči * MeSH
• lidé MeSH
• močení fyziologie   MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Bolestivé výkony sú súčasťou intenzívnej starostlivosti o nedonosených a kriticky chorých novorodencov. Bolesť v novorodeneckom veku má nepriaznivé krátkodobé aj dlhodobé následky na vývoj jedinca. Z toho dôvodu majú byť bolestivé procedúry minimalizované, a ak nejde o urgentné, život zachraňujúce výkony, výkony majú byť dôsledne naplánované s ohľadom na analgetickú prípravu. Prejavy bolesti je potrebné u hospitalizovaných novorodencov sledovať, bolesť má byť systematicky hodnotená spoľahlivým skórovacím systémom. Pri každej potenciálne bolestivej procedúre má byť zabezpečená adekvátna prevencia a redukcia bolesti s ohľadom na aktuálne literárne údaje, typ výkonu a charakteristiky konkrétneho novorodenca. Nefarmakologické stratégie kontroly bolesti by mali byť používané vždy, keď je to možné. Ak sú indikované farmakologické intervencie, je vhodné kombinovať ich s nefarmakologickými. Obavy z nežiaducich účinkov liekov nemajú viesť k tolerancii procedurálnej bolesti. Je však dôležité pamätať na zraniteľnosť vyvíjajúceho sa organizmu zo širšej a dlhodobej perspektívy.

Painful procedures are unavoidable in care of preterm and critically ill neonates in the NICU. Neonatal pain has the potential for shortterm and long-term adverse sequelae. Therefore, the number of painful procedures should be controlled to the minimum. If a procedure is not urgent and life-saving, it has to be carefully planned, deciding for appropriate pain control strategies. Pain indicators have to be monitored, it is essential to use reliable pain assessment tools. Novel evidence, type of procedure and infant’s characteristics have to be considered in order to prevent and reduce procedural pain adequately. Nonpharmacological techniques to control pain should be employed whenever possible. When pharmacological strategies are being administered, it is effective to combine them with nonpharmacological methods. Fear of medications' adverse effects should not result in tolerance of procedural pain in neonates. However, vulnerability of neonatal organism and long-term neurodevelopmental outcome have to be kept in mind.

• MeSH
• intenzivní péče o novorozence MeSH
• lidé MeSH
• měření bolesti MeSH
• neopioidní analgetika aplikace a dávkování   terapeutické užití   MeSH
• novorozenec nedonošený * MeSH
• novorozenec MeSH
• opioidní analgetika aplikace a dávkování   terapeutické užití   MeSH
• procedurální bolest * farmakoterapie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• přehledy MeSH

White Matter Lesions (WML) are a radiological finding common in aged subjects. We explored the impact of WML on underlying neurodegenerative processes. We focused on the impact of WML on two neurodegenerative diseases with different pathology. In this cross-sectional study of 137 subjects (78 female, 59 men, mean age 67.2; 43-87 years), we compared WML in healthy controls (HC; n = 55), patients with Alzheimer's disease and amnestic Mild Cognitive Impairment (aMCI), and Parkinson's disease patients with normal cognition and with MCI. Subjects with AD and aMCI were treated as one group (n = 40), subjects with PD and PDMCI were another group (n = 42). MRI T2_FLAIR sequences were analyzed. WML were divided into periventricular (pWML) or subcortical (sWML) depending on their distance from the ventricles. Subjects from the AD + aMCI group, had a significantly greater volume of WML than both HC and the PD + PDMCI group. The volume of WML was greater in the PD + PDMCI than in HC but the difference was not significant. In AD + aMCI subjects, sWML and not pWML were related to a decrease in global cognitive functioning despite greater volume of pWML. In PD + PDMCI, pWML correlate with decline in executive functions and working memory. In HC, pWML correlated with the multidomain decrease corresponding with the aging. This points to a difference between normal aging and pathological aging due to AD and PD brain pathology. The WML location together with underlying disease related neurodegeneration may play a role in determining the effect of WML on cognition. Our results suggest that the impact of WML is not uniform in all patients; rather, their volume, location and cognitive effect may be disease-specific.

• MeSH
• Alzheimerova nemoc * komplikace   diagnostické zobrazování   patologie   MeSH
• bílá hmota * diagnostické zobrazování   patologie   MeSH
• kognice MeSH
• kognitivní dysfunkce * komplikace   etiologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nemoci nervového systému * MeSH
• neuropsychologické testy MeSH
• Parkinsonova nemoc * komplikace   diagnostické zobrazování   patologie   MeSH
• progrese nemoci MeSH
• průřezové studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: From 2012 to 2013, there was a mass methanol poisoning outbreak in the Czech Republic. Methanol metabolites can cause specific lesions in the basal ganglia, subcortical white matter, and optic nerve. However, long-term sequelae of methanol poisoning on cognitive functioning have not yet been explored. The current study aimed to delineate the cognitive changes observed in methanol poisoning survivors in the seven years since 2012. METHODS: We conducted longitudinal research with repeated measurements in 2013, 2015, 2017 and 2019 to evaluate the development of cognitive changes after acute methanol poisoning. A complex neuropsychological battery consisted of tests of global cognitive performance, auditory and visual attention, executive functioning, learning and memory, working memory and language. Motor performance measures and depression scale were also included. RESULTS: Repeated measures ANOVA of four measurements with post-hoc tests showed a significant decline in the Mini-Mental State Examination (p = 0.007); however, other parameters were not significantly decreasing. In comparison to normative values, the z-scores for each test measure, in the memory domain, in particular, ranged from 43 to 60 % of participants below 1.5 SD. Mild to severe depression levels from the onset of poisoning improved during the seven years, returning to normal in up to 27 % of participants. CONCLUSION: In the longitudinal perspective, methanol poisoning survivors manifest progressive global cognitive decline and overall persistent below-average cognitive performance with some improvements in the frequency of depressive symptoms.

• MeSH
• časové faktory MeSH
• deprese chemicky indukované   diagnóza   epidemiologie   psychologie   MeSH
• dospělí MeSH
• epizodická paměť * MeSH
• kognice účinky léků   MeSH
• kognitivní dysfunkce chemicky indukované   diagnóza   epidemiologie   psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• methanol otrava   MeSH
• mladý dospělý MeSH
• neuropsychologické testy MeSH
• neurotoxické syndromy diagnóza   epidemiologie   psychologie   MeSH
• poruchy paměti chemicky indukované   diagnóza   epidemiologie   psychologie   MeSH
• prevalence MeSH
• senioři 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

OBJECTIVES: To fill the existing research gap related to long-term costs of postacute care in methanol poisoning survivors, healthcare cost for 6 years after the outbreak has been modelled and estimated. DESIGN: In a prospective longitudinal cohort study, data collected from 55 survivors of the Czech methanol mass poisoning outbreak in 2012 were collected in four rounds (5 months, then 2, 4 and 6 years after the discharge) in the General University Hospital in Prague according to the same predefined study protocol. The collected data were used to inform the cost model. SETTING AND PARTICIPANTS: All 83 patients discharged from a hospital poisoning treatment after the 2012 methanol outbreak were informed about the study and invited to participate. Fifty-five patients (66%) gave their written informed consent and were followed until their death or the last follow-up 6 years later. The costs were modelled from the Czech healthcare service (general health insurance) perspective. MAIN OUTCOME MEASURES: Long-term national budget impact of the methanol poisoning outbreak, frequencies of sequelae and their average costs. RESULTS: The postacute cost analysis concentrated on visual and neurological sequelae that were shown to be dominant. Collected data were used to create process maps portraying gradual changes in long-term sequelae over time. Individual process maps were created for the central nervous system, peripheral nervous system, sequelae detected during eye examinations and sequelae concerning the visual evoked potentials. Based on the process maps the costs of the postacute outpatient care were estimated. CONCLUSIONS: In 2013-2019 the highest costs per patient related to postacute care were found in the first year; the average costs decreased afterwards, and remained almost constant for the rest of the studied period of time. These costs per patient ranged from CZK4142 in 2013 to CZK1845 in 2018, when they raised to CZK2519 in 2019 again.

• MeSH
• epidemický výskyt choroby MeSH
• lidé MeSH
• longitudinální studie MeSH
• methanol * MeSH
• náklady na zdravotní péči MeSH
• otrava * epidemiologie   MeSH
• přežívající MeSH
• prospektivní studie MeSH
• subakutní péče MeSH
• zrakové evokované potenciály MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Methanol is a widely used industrial short-chain aliphatic alcohol with known neurotoxic properties. Mass poisoning outbreaks due to the consumption of methanol-adulterated alcoholic drinks present a challenge to healthcare providers due to the high mortality and serious central nervous system (CNS) damage in survivors. However, the impact of methanol exposure on the peripheral nervous system is unknown. OBJECTIVES: To investigate the role of acute methanol exposure in the development of peripheral polyneuropathy (PNP) during the years following discharge from the hospital. METHODS: A total of 55 patients with confirmed methanol poisoning (mean age of 47.9 ± 3.6 years; 9 females) were examined 4 times within a 6-year prospective longitudinal cohort study. The program included neurological and electromyographic examinations, visual evoked potentials, ocular examinations with retinal nerve fibre layer thickness measurements, brain magnetic resonance imaging, and a series of biochemical and toxicological tests. RESULTS: PNP was observed in 20/55 (36 %) patients, which, in most of the cases, was mild axonal sensorimotor neuropathy. In 8/55 (15 %) patients, worsening of electromyographic findings was registered during the follow-up period, including 5 cases with newly diagnosed PNP and 3 cases of PNP progression. In one subject, complete reversal of PNP was registered after cessation of alcohol intake. The patients with PNP were significantly older (57.3 ± 5.3 versus 42.5 ± 3.9 years; p < 0.001), with higher blood glucose (5.93 ± 0.97 versus 4.81 ± 0.32 mmol/L; p = 0.035) and lower vitamin B1 (45.5 ± 7.4 versus 57.5 ± 5.2 ug/L; p = 0.015) concentrations. The number of chronic alcohol abusers was significantly higher in the PNP group (17/20 versus 20/35; p = 0.034). No associations between PNP prevalence/ dynamics and acute parameters of poisoning severity, arterial blood pH (7.26 ± 0.07 with PNP versus 7.18 ± 0.09 without PNP; p = 0.150), or serum methanol (1320.0 ± 700.0 with PNP versus 1430.0 ± 510.0 mg/L without PNP; p = 0.813) and ethanol (460.0 ± 560.0 with PNP versus 340.0 ± 230.0 mg/L without PNP; p = 0.675) concentrations at admission were found. No difference in the number of patients with visual (9/20 with PNP versus 12/35 patients without PNP; p = 0.431) and CNS sequelae (9/20 with PNP versus 15/35 patients without PNP; p = 0.877) of poisoning was present. DISCUSSION: Despite the relatively high number of PNP cases, no association was found between the severity of acute methanol poisoning and the prevalence of PNP and its dynamics during six years of observation. We did not find an association between methanol-induced visual/ brain damage and the prevalence of PNP in survivors of poisoning. A high prevalence of PNP and its progression might be attributed to other causes, mainly a history of chronic alcohol abuse and insufficiently treated diabetes mellitus. Our results highlight the importance of complete cessation of alcohol consumption and better control of glycaemia in diabetic patients in the prevention and treatment of peripheral PNP.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• methanol otrava   MeSH
• nemoci periferního nervového systému chemicky indukované   diagnóza   epidemiologie   MeSH
• otrava diagnóza   epidemiologie   MeSH
• prevalence MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Sequelae of poliomyelitis, coupled with asymmetric impairment and weight-bearing, typically alter walking biomechanics which can be associated with the knee and ankle osteoarthritis. AIM: We aimed to investigate whether the distal femoral and talar cartilage thicknesses were different in patients with poliomyelitis. DESIGN: Cross-sectional observational study. SETTING: Outpatients, tertiary care center. POPULATION: Thirty-six patients (12 males, 24 females) with a history of poliomyelitis and 36 age, gender and body mass index similar healthy subjects (11 males, 25 females) were enrolled. Mean values for age, body mass index and age of the poliomyelitis onset were 70.2±4.6 years, 27.2±5.7 kg/m2, and 3.6±2.4 years. METHODS: Visual Analogue Scale (VAS) was used to assess pain. Lower limb muscle strengths were measured by manual muscle testing. The more affected side was identified according to the lower limb manual muscle testing. Bilateral distal femoral cartilage from the lateral femoral condyle, intercondylar area, medial femoral condyle and talar cartilage thicknesses were measured using ultrasound imaging. RESULTS: Among patients, the onset of poliomyelitis was at 3.6±2.4 years of age, and Functional Ambulation Category scores were 5 (3-5). VAS scores were similar between the sides affected more and less by poliomyelitis. All cartilage thicknesses (except the talar cartilage) of the patients were found to be thinner on the more affected side than the less affected side (all P<0.001). The thickness of talar cartilage was thinner compared to control subjects (P<0.001). Among the patients, quadriceps muscle strength was positively correlated with medial condyle (r=0.377, P=0.024), intercondylar area (r=0.399, P=0.016) and lateral condyle (r=0.363, P=0.030) thicknesses. Knee VAS scores were negatively correlated with talar cartilage thicknesses (r=-0.393, P=0.018). CONCLUSIONS: We found a thinning of the distal femoral condyle in the more affected paretic sides of poliomyelitis patients as compared to both those of less affected sides and those of healthy controls. Talar cartilages on both sides of the patients were thinner compared to control subjects. CLINICAL REHABILITATION IMPACT: Our preliminary findings may contribute to the long-term management of patients with long-term poliomyelitis sequelae.

• MeSH
• femur diagnostické zobrazování   MeSH
• hlezenní kloub diagnostické zobrazování   MeSH
• kloubní chrupavka diagnostické zobrazování   MeSH
• kolenní kloub diagnostické zobrazování   MeSH
• lidé MeSH
• měření bolesti MeSH
• poliomyelitida diagnostické zobrazování   MeSH
• průřezové studie MeSH
• senioři MeSH
• svalová síla MeSH
• talus diagnostické zobrazování   MeSH
• ultrasonografie * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Úvod: V našem souboru byly hodnoceny výsledky zadní transpedikulární fixace s použitím PMMA fenestrovaných šroubů u osteoporotických zlomenin obratlů hrudní a bederní páteře s nebo bez přítomného neurodeficitu. Metody: Předmětem sledování byl klinický efekt operace, od ledna 2014 do prosince 2016 jsme zhodnotili 31 pacientů s potvrzenou osteoporotickou zlomeninou, kteří podstoupili transpedikulární fixaci s použitím fenestrovaných PMMA augmentovaných šroubů. V souboru byl hodnocen klinický stav pomocí vizuální analogové škály (VAS) a Oswestry Disability Index (ODI). Délka sledování byla minimálně 2 roky. Výsledky: Hodnoty VAS (snížení z 8,1 na 3,6) a ODI (snížení ze 76 na 34) poukazují na významné snížení lokálních bolestí i invalidity. Asymptomatický únik cementu se vyskytl u 7 pacientů, další méně závažné komplikace byly též zhodnoceny a zaznamenány. Radiologické zhodnocení poukazuje na zlepšení lokální kyfózy, s raritním výskytem selhání instrumentace. Závěr: Augmentovaná transpedikulární fixace s kanylovanými šrouby je dobře proveditelná a relativně bezpečná chirurgická technika pro ošetření porotických zlomenin páteře. Důležitými faktory jsou selekce vhodných pacientů a správné technické provedení výkonu.

Introduction: We assessed our results of posterior transpedicular fixation using PMMA augmented fenestrated screws for osteoporotic vertebral fractures of thoracic or lumbar spine with or without neurological deficits. Methods: From January 2014 to December 2016, 31 patients with confirmed osteoporotic (T-score <-2.5) vertebral fractures underwent pedicular screw fixation using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. The patients had radiographic follow-up examinations after 1, 3, 6, and 12 months and once per year thereafter, with the minimum follow-up duration of 2 years.Results: The Visual Analog Scale (decreased from 8.1 to 3.6) and Oswestry Disability Index (decreased from 76 to 34) scores showed a significant reduction of local pain and disability (p <0.01). Asymptomatic cement leakage occurred in seven patients, without any neurological sequelae; other less serious complications were also observed. Radiological observation indicated a satisfactory improvement of local kyphosis, without significant loosening or pulling out of the screws.Conclusion: The polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws is a feasible and rela-tively safe method for operative management of osteoporotic vertebral fractures. Crucial factors for successful use of augmented screws include careful patient selection and proper technique implementation.

• MeSH
• fraktury páteře chirurgie   MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury * chirurgie   MeSH
• pozorovací studie jako téma MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• Publikační typ
• učebnice MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• vnitřní lékařství
• NLK Publikační typ
• kolektivní monografie

Purpose: The effect of acute methanol poisoning on the follow-up quality of life of survivors in mass poisoning outbreaks is not known. The objective of this is to study the impact of visual and central nervous system (CNS) sequelae of methanol poisoning on long-term health-related quality of life (QoL) of survivors, its clinical determinants, and dynamics.Materials and methods: A total of 54 patients with confirmed methanol poisoning (mean age 46.7 ± 13.4 years, 9 females) were examined consequently three times within six-year prospective cohort study and compared to 23 controls with the history of chronic alcohol abuse. The following tests were performed: SF-36 QoL questionnaire, visual evoked potentials (VEP) of optic nerve, ocular examination with retinal nerve fiber layer (RNFL) thickness measurement, brain magnetic resonance imaging (MRI), and biochemical and toxicological tests.Results: Acute methanol poisoning led to significant decrease in physical component summary (PCS) compared to PCS of age-adjusted controls (mean score with SD 46.8 ± 11.0 versus 52.3 ± 9.4 points; p = .003). In 17/40 (42.5%) patients with three rounds of examination, signs of severe disability (≤30 points in at least one score) were present six years after discharge, with negative dynamics of PCS score during the observation period. The patients with abnormal RNFL thickness had lower PCS (mean difference 10.5 points; 95%CI 3.5-17.5, p = .004) and mental component summary score (9.5 points; 95%CI 1.9-17.1, p = .015) compared to the patients with normal RNFL. Signs of physical and mental adaptation to long-term visual sequelae were registered with gradual reduction of difference in most of physical and mental components scores compared to the patients with normal RNFL during six years of observation. Signs of hemorrhagic brain lesions were associated with permanent decrease of PCS score (mean difference 7.4 points; 95%CI 0.6-14.0; p = .033), bodily pain (8.7 points; 95%CI 1.6-17.6; p = .018), and social functioning (8.2 points; 95%CI 3.0-17.4; p = .005) six years after discharge. No effect of type of antidote (fomepizole versus ethanol) and extracorporeal enhanced elimination modality (intermittent hemodialysis versus continuous renal replacement therapy) applied in hospital on long-term QoL was found (all p > .05).Conclusion: Acute methanol poisoning was associated with a significant decrease of health-related quality of life of survivors persisting for at least six years after discharge. The more pronounced decrease in QoL scores was observed in the patients with hemorrhagic brain lesions and visual sequelae of poisoning with abnormal RNFL thickness.

• MeSH
• alkoholismus komplikace   MeSH
• antidota aplikace a dávkování   MeSH
• dospělí MeSH
• epidemický výskyt choroby * MeSH
• ethanol aplikace a dávkování   MeSH
• fomepizol aplikace a dávkování   MeSH
• kohortové studie MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• methanol otrava   MeSH
• mozek diagnostické zobrazování   MeSH
• následné studie MeSH
• přežívající MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• retina patologie   MeSH
• zrakové evokované potenciály MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH