The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• MeSH
• Consensus * MeSH
• Humans MeSH
• Lymphatic Metastasis * diagnostic imaging   MeSH
• Lymph Nodes * diagnostic imaging   pathology   MeSH
• Genital Neoplasms, Female * diagnostic imaging   pathology   MeSH
• Neoplasm Staging * MeSH
• Terminology as Topic MeSH
• Ultrasonography * methods   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Psycholog v zařízeních dlouhodobé péče zastává klíčovou roli v podpoře seniorů, spolupráci s personálem, komunikaci s rodinami a osvětě směrem k veřejnosti. Jeho práce zahrnuje individuální i skupinové intervence, přizpůsobené zdravotnímu stavu klientů, smyslovým deficitům a specifickým komunikačním potřebám. Důležitou součástí je i doprovázení seniorů v tématech umírání a bilancování života. Dalším aspektem psychologické práce je začlenění do multidisciplinárního týmu, kde poskytuje psychologický pohled na situaci klienta, pomáhá zlepšovat komunikaci mezi jednotlivými úseky péče a působí jako mediátor. Zároveň plní advokační roli, kdy hájí práva klientů a podporuje jejich důstojnost a autonomii. Přestože tato role má významný přínos, psychologové nejsou v českých domovech pro seniory systematicky zastoupeni. Článek proto zdůrazňuje potřebu systémové změny, vytvoření odborných standardů a větší integrace psychologické péče do zařízení dlouhodobé péče. Klíčovou roli v tomto procesu hraje vzdělávání psychologů a podpora výzkumu zaměřeného na duševní zdraví seniorů.

A psychologist in long-term care facilities plays a key role in supporting older adults, collaborating with staff, communicating with families, and raising public awareness. Their work includes individual and group interventions, adapted to the health status of residents, sensory deficits, and specific communication needs. An important aspect is also providing support in end-of-life discussions and life review. Another crucial function of the psychologist is integration into the multidisciplinary team, where they provide a psychological perspective on residents’ situations, facilitate communication between care departments, and act as mediators. Additionally, they fulfill an advocacy role, protecting residents’ rights and promoting dignity and autonomy. Despite the significant benefits of this role, psychologists are not systematically represented in Czech long-term care facilities. This article emphasizes the need for systemic change, the development of professional standards, and the greater integration of psychological care into long-term care settings. A key aspect of this process is the education of psychologists and the promotion of research focused on the mental health of older adults.

BACKGROUND: The role of primary healthcare (PHC) during a pandemic varies across European countries. The coronavirus disease 2019 (COVID-19) pandemic has altered the working practices of family medicine doctors and impacted the resilience of healthcare systems. OBJECTIVES: This study aimed to examine European healthcare system responses to the pandemic, focusing on rural and urban differences. MATERIAL AND METHODS: This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from 16 European Rural and Isolated Practitioners Association (EURIPA) member countries distributed questionnaires to 406 PHC doctors. Data were analyzed using descriptive statistics and nonparametric tests (χ2, Kruskal-Wallis, Mann-Whitney U) with a significance threshold of 0.05. RESULTS: A statistically significant difference was found between rural (36.4%, 55/151), semirural (19.4%, 24/124) and urban populations (29.8%, 39/131) regarding medicine shortages (χ2 = 9.91, degrees of freedom (df) = 4, p = 0.042). The semirural setting showed a statistically significant difference from the other settings (p = 0.004 in post hoc χ2 test). Significant differences were found between countries in resilience features including, effectiveness of triage, adapting to the rapidly changing requirements, government help, existence of a community resilience group, improved interprofessional collaboration, medicine shortage, and general practitioners (GPs) involvement in palliative care. CONCLUSIONS: Medicine shortage was more prevalent in rural and urban areas compared to semirural areas. Differences were observed between countries in their responses to the pandemic, particularly in adapting to the rapidly changing requirements, effectiveness of triage, government help, and the existence of a community resilience group. These differences were confirmed with qualitative analysis. The results emphasize the need for tailored approaches considering diverse contexts in shaping effective healthcare system resilience.

• MeSH
• COVID-19 * epidemiology   MeSH
• Humans MeSH
• Pandemics MeSH
• Primary Health Care * organization & administration   MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• SARS-CoV-2 MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

INTRODUCTION: The aim of the TALENT project is to promote equality in education, prevent exclusion, support dual careers (sport and school), create new role models for the benefit of young talents and prepare them for lifelong learning and professional sport from an early age. It is promoted by a European consortium of 7 partner institutions and runs from December 2022 to May 2025. It consists of five work packages. In the first work phase, developing the WP2 (from December 2022 to October 2023), under the coordination of UNIPA, NIS University, KMOP and EAS standards for talent recognition were identified and validated. METHODS: Initially, 12 focus groups were conducted with teachers (77 teachers) and coaches (73 coaches) on creating talent identification standards; subsequently, workshops were held with dual career experts to validate these standards. This was a key piece of work that enabled the establishment of clear guidelines and protocols to identify and support talented young people in their dual careers. RESULTS: A final list of 41 shared statements was identified: 20 related to teachers and 21 related to coaches. For example, teachers emphasized the need for multidisciplinary approaches and early identification of talent, while coaches underlined the importance of psychological readiness and collaboration with schools and families. DISCUSSION: These statements not only provide structured reference points for talent identification but also highlight actionable needs across educational and sport systems. As such, they represent a solid foundation for developing standard operating procedures in talent recognition and dual career support.

• Publication type
• Journal Article MeSH

Autoři jsou uváděni v abecedním pořadí, podíl jednotlivých autorů je uveden na konci práce. Souhrn doporučení Preventivní opatření a postupy Doporučujeme, aby v průběhu porodu u žen s rizikovými faktory pro PPH byla sledována krevní ztráta s využitím kalibrovaných kolektorů krve nebo jejich ekvivalentů. (Dobrá klinická praxe) Doporučujeme, aby ženy se závažnými rizikovými faktory pro PŽOK (např. placenta acrreta spectrum nebo hematologické poruchy vyžadující konziliární hematologickou péči) rodily v perinatologickém centru intenzivní péče nebo v perinatologickém centru intermediární péče. (Dobrá klinická praxe) Doporučujeme u pacientek s vysokým rizikem PŽOK v přiměřeném časovém předstihu před porodem formulování plánu péče za účasti multidisciplinárního týmu. (Dobrá klinická praxe) Doporučujeme léčbu anemie antepartálně. Těhotným ženám by měly být podávány preparáty železa, pokud hladina hemoglobinu klesne v I. trimestru < 110 g/l nebo < 105 g/l ve 28. týdnu těhotenství. (Dobrá klinická praxe) Navrhujeme zvážit parenterální podání železa u žen se sideropenickou anemií, nereagující na suplementaci železa perorální cestou. Příčina anemie by měla být zjištěna co nejdříve po ukončení těhotenství. (Slabé doporučení) Pokud se dítě dobře adaptuje, nedoporučujeme dřívější podvaz pupečníku než za 1 min. (Silné doporučení) Doporučujeme pro snížení rizika rozvoje PPH a PŽOK u všech vaginálních porodů profylaktické podání uterotonik ve III. době porodní po porodu dítěte a po podvazu pupečníku. Lékem první volby je oxytocin. (Silné doporučení) Pokud nebyla aktivně vedena III. doba porodní, navrhujeme pro zkrácení trvání III. doby porodní a pro snížení krevní ztráty u vaginálního porodu zvážit provedení masáže dělohy a řízenou trakci za pupečník, provádí-li ji kvalifikovaná osoba. (Slabé doporučení) Doporučujeme podání uterotonik k prevenci rozvoje PPH u žen po vybavení dítěte císařským řezem a po podvazu pupečníku. (Silné doporučení) Navrhujeme zvážit u žen se zvýšeným rizikem PŽOK podání carbetocinu. (Slabé doporučení) Doporučujeme u žen se zvýšeným rizikem PŽOK podstupujících císařský řez jednorázové podání kyseliny tranexamové (TXA). Klinická poznámka: Použití TXA před provedením císařského řezu není explicitně uvedeno v SPC přípravku. Recentní metaanalýza uvádí nejčastější dávkování 1 g i.v. (Silné doporučení) Organizace poskytování péče Doporučujeme, aby každé zdravotnické zařízení, kde je gynekologicko-porodnické pracoviště, mělo pro situace PŽOK vypracováno řízený dokument definující organizační a odborný postup. (Dobrá klinická praxe) Doporučujeme, aby řízený dokument (tj. krizový plán) jednoznačně vymezoval organizační a odborné role jednotlivých členů krizového týmu při vzniku PŽOK (nelékařský personál, porodník, anesteziolog, hematolog apod.) a definoval minimální rozsah vybavení pracoviště pro zajištění péče o pacientky s PŽOK. (Dobrá klinická praxe) Doporučujeme pravidelný simulační trénink krizové situace PŽOK celým krizovým týmem s následným debrífinkem nebo jeho formalizovaným ekvivalentem. (Dobrá klinická praxe) Doporučujeme na každém pracovišti definování indikátorů kvality diagnostiky a léčby PŽOK a jejich formalizované vyhodnocování v pravidelných intervalech, nejméně jednou ročně. (Dobrá klinická praxe) Diagnostický a léčebný postup při PŽOK Při nálezu hypotonie nebo atonie dělohy doporučujeme používat strukturovaný stupňovitý postup. (Dobrá klinická praxe) Na pracovištích s dostupností endovaskulárních intervencí navrhujeme u stavů PŽOK z důvodu hypotonie nebo atonie dělohy zvážit preferenční využití radiologických intervenčních metod (selektivní embolizace pánevních tepen), pokud to aktuální klinický kontext umožňuje. (Slabé doporučení) U všech stavů rozvoje PPH doporučujeme provedení tzv. předtransfuzního vyšetření. Pro posouzení aktuálního stavu koagulace jsou (kromě standardních laboratorních vyšetření) preferovány metody tzv. point-of-care-testing, zejména viskoelastické metody. (Dobrá klinická praxe) Každé porodnické pracoviště by mělo mít ve spolupráci s transfuzním oddělením a ústavní lékárnou trvale dostatečnou zásobu transfuzních přípravků a krevních derivátů pro jejich bezprostřední dostupnost v režimu 24/7. Doporučujeme u stavů rozvoje PŽOK zajistit iniciálně dostupnost čtyř transfuzních jednotek plazmy (preferována je tzv. solvent/detergent ošetřená plazma), čtyř transfuzních jednotek erytrocytů a 6 g fibrinogenu. Za minimální zásobu fibrinogenu považujeme 8 g fibrinogenu a dostupnost dalších 8 g do 1 hod. (Dobrá klinická praxe) Doporučujeme u všech pacientek s PPH zahájit okamžitou tekutinovou resuscitaci. Pro zahájení tekutinové resuscitace doporučujeme použití balancovaných roztoků krystaloidů. (Silné doporučení) Navrhujeme zvážit použití syntetických koloidních roztoků s obsahem želatiny při nedosažení nebo nedosahování hemodynamických cílů tekutinové resuscitace použitím krystaloidních roztoků a při trvající potřebě tekutin. (Slabé doporučení) Do doby dosažení kontroly zdroje krvácení doporučujeme u pacientek s PŽOK usilovat o dosažení hodnoty systolického krevního tlaku v pásmu 80–90 mmHg. (Silné doporučení) Doporučujeme u PŽOK použít vazopresory co nejdříve při nemožnosti dosažení cílových hodnot arteriálního krevního tlaku probíhající tekutinovou resuscitací. (Silné doporučení) V diagnostice a léčbě koagulopatie u PŽOK nereagujícího na standardní léčebné postupy doporučujeme spolupráci s hematologem. (Dobrá klinická praxe) K identifikaci typu koagulační poruchy u PŽOK, k její monitoraci a pro cílenou léčbu poruchy hemostázy doporučujeme kromě výše uvedených skupinových laboratorních vyšetření (minimálně KO, aPTT, fibrinogen) používat i viskoelastické metody (ROTEM, TEG). (Silné doporučení) K dosažení/obnovení účinnosti endogenních hemostatických mechanismů a léčebných postupů podpory koagulace doporučujeme maximální možnou korekci hypotermie, acidózy a hladiny ionizovaného kalcia. (Silné doporučení) Doporučujeme časné zahájení všech dostupných postupů k prevenci hypotermie a udržení nebo dosažení normotermie. (Silné doporučení) Doporučujeme monitorovat a udržovat hladinu ionizovaného kalcia v normálním referenčním rozmezí při podávání transfuzních přípravků. Ke korekci byl měl být přednostně podáván chlorid vápenatý. (Silné doporučení) Substituci fibrinogenu doporučujeme u pacientek s PPH při poklesu jeho hladiny < 2 g/l a/nebo při nálezu jeho funkčního deficitu zjištěném viskoelastickými metodami a/nebo při odůvodněném klinickém předpokladu deficitu fibrinogenu i bez znalosti jeho hladin. Jako úvodní dávku u PŽOK doporučujeme podání minimálně 4 g fibrinogenu. (Silné doporučení) Doporučujeme podat kyselinu tranexamovou (TXA) v úvodní dávce 1 g i.v. co nejdříve po vzniku PŽOK. Identická dávka může být opakována (nejdříve po 30 min), pokud krvácení pokračuje a je-li současně prokázána hyperfibrinolýza a/nebo je-li v aktuálním klinickém kontextu hyperfibrinolýza vysoce pravděpodobná. (Silné doporučení) Po dosažení kontroly krvácení další podání TXA u pacientek s PŽOK nedoporučujeme. (Silné doporučení) Doporučujeme podání plazmy v dávce 15–20 ml/kg u stavů PPH, kde je předpoklad koagulopatie jiné etiologie, než je nedostatek fibrinogenu a/nebo jsou přítomny abnormální výsledky koagulačních vyšetření, a kdy jejich výsledky neumožní identifikovat spolehlivě převažující mechanizmus koagulační poruchy a její cílenou korekci. (Silné doporučení) Doporučujeme podání faktorů protrombinového komplexu (PCC) u pacientek s PŽOK, kde je laboratorně prokázán deficit faktorů v PCC obsažených. Rutinní podávání PCC u pacientek s PŽOK nedoporučujeme. (Silné doporučení) Navrhujeme zvážit podání rFVIIa v době před rozhodnutím o endovaskulární nebo chirurgické intervenci. (Slabé doporučení) Doporučujeme u pacientek s PŽOK podávání erytrocytárních transfuzních přípravků k dosažení cílové hodnoty hemoglobinu v pásmu 70–80 g/l. (Silné doporučení) Doporučujeme u pacientek s PŽOK podávání trombocytů k dosažení cílové hodnoty minimálně 50 × 109/l a/nebo při předpokladu či průkazu poruchy jejich funkce. (Silné doporučení) Nedoporučujeme rutinní měření hladin antitrombinu III u pacientek s PŽOK. (Silné doporučení) Nedoporučujeme rutinní substituci antitrombinu III u pacientek s PŽOK. (Silné doporučení) Doporučujeme zahájit farmakologickou profylaxi trombembolické nemoci co nejdříve po dosažení kontroly zdroje PPH. Mechanickou tromboprofylaxi (intermitentní pneumatická komprese anebo elastické punčochy) doporučujeme zahájit neprodleně, jakmile to klinický stav dovolí. (Silné doporučení)

Summary of recommendations Preventive measures and procedures We recommend monitoring of blood loss in women with risk factors for PPH during labor using calibrated blood collectors or their equivalents. (Good Clinical Practice) We recommend that women with significant risk factors for PPH (e.g., placenta acrreta spectrum or hematologic disorders requiring consultative hematologic care) deliver in a perinatal intensive care center or perinatal intermediate care center. (Good Clinical Practice) We recommend formulating a plan of care in collaboration with a multidisciplinary team at a reasonable time prior to delivery for patients at high risk of PPH. (Good Clinical Practice) We recommend treating anemia antepartally. Pregnant women should be given iron supplements if the haemoglobin level falls to < 110 g/L in the 1st trimester or < 105 g/L at 28 weeks of pregnancy. (Good Clinical Practice) We suggest considering parenteral iron administration in women with sideropenic anemia unresponsive to oral iron supplementation. The cause of anemia should be identified as soon as possible after termination of pregnancy. (Weak recommendation) If the baby adapts well, we do not recommend cord ligation in less than 1 min. (Strong recommendation) In all vaginal deliveries, we recommend prophylactic administration of uterotonics in the third postpartum period after the delivery of the baby and cord ligation to reduce the risk of PPH. The first-choice drug is oxytocin. (Strong recommendation) If the third stage of labor has not been actively managed, we suggest that uterine massage and controlled umbilical cord traction be considered to shorten the duration of the third stage of labor and to reduce blood loss during vaginal delivery, if performed by a qualified healthcare professional. (Weak recommendation) We recommend the administration of uterotonics to prevent the development of PPH in women after the delivery of a child by caesarean section and umbilical cord ligation. (Strong recommendation) We suggest considering carbetocin administration in women at increased risk of PPH. (Weak recommendation) We recommend a single-dose administration of tranexamic acid (TXA) in women at increased risk of PPH undergoing a caesarean section. Clinical note: The use of TXA prior to the caesarean section is not explicitly stated in the product's SPC. A recent meta-analysis states the most common dosage to be 1 g i.v. (Strong recommendation) Organization of care We recommend that every health care facility with an OB/GYN unit should have the PPH management protocol (guided document is not specific or really used at all, I am not sure if my suggestion is sufficient) defining the organizational and professional procedure for PPH situations. (Good Clinical Practice) We recommend that the PPH management protocol (i.e. the crisis action plan) should clearly define the organizational and professional roles of the individual members of the crisis team in the event of PPH (non-medical staff), obstetrician, anesthetist, hematologist, etc.) and define the minimum scope of equipment for the care of patients with PPH. (Good Clinical Practice) We recommend regular simulation training of PPH crisis by the entire crisis team with a subsequent debriefing or its formalized equivalent. (Good Clinical Practice) We recommend defining quality indicators for the diagnosis and treatment of PPH and their formalized evaluation at regular intervals, at least once a year. (Good Clinical Practice) Diagnostic and treatment procedure at PPH When hypotonia or atony of the uterus is found, we recommend using a structured procedure. (Good Clinical Practice) At departments with an option of endovascular interventions, we suggest considering the preferential use of radiological interventional methods (selective pelvic artery embolization) in cases of PPH due to uterine hypotonia or atony, if the current clinical context allows it. (Weak recommendation) For all stages of PPH development, we recommend a pre-transfusion examination. In addition to standard laboratory tests, point-of-care-testing methods, especially viscoelastic methods, are preferred to assess the current coagulation status. (Good Clinical Practice) Each obstetric unit should ensure a sufficient stock of blood products and blood derivatives for their immediate availability 24/7 in collaboration with the transfusion department and the inpatient pharmacy. In case of PPH development, we recommend securing initial availability of 4 units of plasma (solvent/detergent-treated plasma is preferred), 4 units of erythrocytes and 6 g of fibrinogen. We consider 8 g to be a minimum supply of fibrinogen and additional 8 g should be available within 1 h. (Good Clinical Practice) We recommend the initiation of immediate fluid resuscitation in all patients with PPH. We recommend the use of balanced crystalloid solutions to initiate fluid resuscitation. (Strong recommendation) We propose considering the use of synthetic colloid solutions containing gelatin when hemodynamic goals of fluid resuscitation have not been achieved or are not being achieved using crystalloid solutions and when a fluid deficit persists. (Weak recommendation) Until the source of bleeding is controlled, we recommend aiming for a systolic blood pressure in a range of 80–90 mmHg in patients with PPH. (Strong recommendation) We recommend the use of vasopressors as soon as possible in PPH when target arterial blood pressure values cannot be reached by ongoing fluid resuscitation. (Strong recommendation) We recommend cooperation with a hematologist in the diagnosis and treatment of coagulopathy in PPH unresponsive to standard therapies. (Good Clinical Practice) In addition to the above-mentioned panel laboratory tests (at least KO, aPTT, fibrinogen), we also recommend using viscoelastic methods (ROTEM, TEG) to identify the type of coagulation disorder in PPH, to monitor it and for targeted treatment of hemostasis disorders. (Strong recommendation) To achieve/restore the efficacy of endogenous hemostatic mechanisms and coagulation support therapies, we recommend the maximum possible correction of hypothermia, acidosis and ionized calcium levels. (Strong recommendation) Early initiation of all available procedures to prevent hypothermia and maintain or achieve normothermia is recommended. (Strong recommendation) It is recommended monitoring and maintaining ionized calcium levels within the normal range when administering transfusion products. Preferably, calcium chloride should be administered for correction. (Strong recommendation) Fibrinogen replacement is recommended in patients with PPH when fibrinogen levels fall to < 2 g/L and/or when there is a functional fibrinogen deficiency detected by viscoelastic methods and/or when there is a reasonable clinical assumption of fibrinogen deficiency even without knowledge of fibrinogen levels. We recommend a minimum of 4 g of fibrinogen as an initial dose in PPH. (Strong recommendation) It is recommended to administer tranexamic acid (TXA) at an initial dose of 1 g i.v. as soon as possible after the onset of PPH. An identical dose may be repeated (after 30 min at the earliest) if bleeding continues and if hyperfibrinolysis is demonstrated and/or if hyperfibrinolysis is highly likely in the current clinical context. (Strong recommendation) We do not recommend further administration of TXA in patients with PPH after bleeding control has been achieved. (Strong recommendation) We recommend administration of plasma at a dose of 15–20 mL/kg in PPH conditions where coagulopathy of a different etiology than fibrinogen deficiency is suspected and/or abnormal coagulation test results are present, and where the results do not reliably identify the predominant mechanism of the coagulation disorder and its targeted correction. (Strong recommendation) We recommend the administration of prothrombin complex factors (PCC) in patients with PPH where there is a laboratory evidence of a deficiency of PCC factors. We do not recommend routine administration of PCC in patients with PPH. (Strong recommendation) We suggest considering administration of rFVIIa before making a decision on an endovascular or a surgical intervention. (Weak recommendation) In patients with PPH, we recommend administration of erythrocyte blood products to achieve a target hemoglobin value in the range 70–80 g/L. (Strong recommendation) In patients with PPH, we recommend platelet administration to achieve a target value of at least 50 × 109/L and/or when platelet function impairment is suspected or demonstrated. (Strong recommendation) We do not recommend routine measurement of antithrombin III levels in patients with PPH. (Strong recommendation) We do not recommend routine antithrombin III replacement in patients with PPH. (Strong recommendation) We recommend initiating pharmacological prophylaxis for thromboembolic disease as soon as possible after control of the source of PPH is achieved. We recommend initiating mechanical thromboprophylaxis (intermittent pneumatic compression or elastic stockings) as soon as the clinical condition permits. (Strong recommendation)

• Keywords
• profylaxe uterotoniky, peripartální krvácení, tlakové a podlatkové nitroděložní prostředky, hemostatické nitroděložní prostředky, viskoelastické metody, krizový management,
• MeSH
• Uterine Hemorrhage * diagnosis   therapy   MeSH
• Factor VIIa MeSH
• Hemorrhage diagnosis   therapy   MeSH
• Humans MeSH
• Peripartum Period MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Practice Guideline MeSH

BACKGROUND: Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below a level that allows normal digestion of nutrients. Pancreatic disease and pancreatic surgery are the main causes of PEI, but other conditions can affect the digestive function of the pancreas. METHODS: In collaboration with European Digestive Surgery (EDS), European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), European Society for Clinical Nutrition and Metabolism (ESPEN), European Society of Digestive Oncology (ESDO), and European Society of Primary Care Gastroenterology (ESPCG) the working group developed European guidelines for the diagnosis and therapy of PEI. United European Gastroenterology (UEG) provided both endorsement and financial support for the development of the guidelines. RESULTS: Recommendations covered topics related to the clinical management of PEI: concept, pathogenesis, clinical relevance, general diagnostic approach, general therapeutic approach, PEI secondary to chronic pancreatitis, PEI after acute pancreatitis, PEI associated with pancreatic cancer, PEI secondary to cystic fibrosis, PEI after pancreatic surgery, PEI after esophageal, gastric, and bariatric surgery, PEI in patients with type 1 and type 2 diabetes, and PEI in other conditions. CONCLUSIONS: The European guidelines for the diagnosis and therapy of PEI provide evidence-based recommendations concerning key aspects of the etiology, diagnosis, therapy, and follow-up, based on current available evidence. These recommendations should serve as a reference standard for existing management of PEI and as a guide for future clinical research. This article summarizes the recommendations and statements.

• MeSH
• Exocrine Pancreatic Insufficiency * diagnosis   therapy   etiology   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH

Idiopathic inflammatory myopathies (IIM), or myositis, are a heterogeneous group of systemic autoimmune disorders that are associated with significant morbidity and mortality. Conducting high-quality clinical trials in IIM is challenging due to the rare and variable presentations of disease. To address this challenge, the Myositis Clinical Trials Consortium (MCTC) was formed. MCTC is a collaborative international alliance dedicated to facilitating, promoting, coordinating and conducting clinical trials and related research in IIM. This partnership works to advance the discovery of effective evidence-based treatments for IIM by integrating a diverse group of clinical investigators, research professionals, medical centres, patient groups, and industry partners. The Steering Committee, Core Group, and Paediatric Subcommittee of MCTC are comprised of myositis experts and junior investigators from around the world, representing a diversity of genders, geographies, and subspecialties. MCTC works alongside other current myositis organisations to complement existing work by concentrating on the operationalisation of clinical trials. Our pilot Myositis Investigators' Information Survey gathered responses from 173 myositis investigators globally and found considerable variability in proficiency with outcome measures, geographic disparities in patient recruitment, and a significant disconnect between investigators' routine myositis patient load and clinical trial enrolment. MCTC will meet the need to support and diversify myositis clinical trials by facilitating trial planning, feasibility assessments, site selection, and the training and mentoring of junior investigators/centres to establish their readiness for clinical trial participation. Through experienced leadership, strategic collaborations, and interdisciplinary discussions, MCTC will establish standards for IIM clinical trial design, protocols, and outcome measures in myositis.

• MeSH
• Child MeSH
• Adult MeSH
• Clinical Trials as Topic * MeSH
• Cooperative Behavior MeSH
• Humans MeSH
• International Cooperation * MeSH
• Adolescent MeSH
• Myositis * therapy   diagnosis   MeSH
• Research Design MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Musculoskeletal disorders, affecting as many as 1.3 billion people worldwide, are the leading cause of disability and impose a substantial health and socioeconomic burden. Despite the high prevalence of these conditions, translational research in this field is far from optimal, highlighting the need for stronger collaboration between basic and clinical scientists. This paper, authored by members of the basic and clinical action groups of the European Calcified Tissue Society (ECTS) and endorsed by the Board of the ECTS, examines the key barriers to effective translational research in musculoskeletal diseases, including clinician workload, differences in professional language and culture, physical distance between research sites, and insufficient interdisciplinary funding. Through interviews with eight institutional managers across five European countries, we observed that in some institutions, the collaboration between basic scientists and clinicians was regarded as no concern (but with room for improvement), and in most institutions it was recognised as a serious issue. We found consensus on the importance of collaboration yet identified discrepancies in the provision of structural and financial support. Based on these findings, we propose strategic initiatives to bridge the gap between basic and clinical research. Suggested measures include dedicated translational funding, integrated research facilities, collaborative scientific forums, strategic collaborations, establishment of physician-scientists, and, finally, bringing basic and clinical researchers together in the same building or even in a combined department. Notable successes, such as the development of the anti-osteoporotic drugs, romosozumab and denosumab, underscore the value of a coordinated approach and exemplify how shared insights between laboratory research and clinical practice can lead to impactful therapeutic advances. Moving forward, we advocate for institutional commitments to foster a robust translational research environment, as well as tailored funding initiatives to support such efforts. This paper serves as a call for discussion and action to enhance interdisciplinary cooperation to advance musculoskeletal medicine and improve outcomes for patients with debilitating musculoskeletal diseases.

• MeSH
• Biomedical Research organization & administration   MeSH
• Cooperative Behavior MeSH
• Humans MeSH
• Musculoskeletal Diseases * therapy   MeSH
• Translational Research, Biomedical * MeSH
• Research Personnel MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

Pulmonary hypertension is a complex and heterogeneous condition with five main subtypes (groups). This review focuses on pulmonary hypertension caused by chronic hypoxia (hypoxic pulmonary hypertension, HPH, group 3). It is based mainly on our own experimental work, especially our collaboration with the group of Professor Herget, whose fifth anniversary of death we commemorate. We have found that oxidation and degradation of the extracellular matrix (ECM) in vitro, in either the presence or the absence of pro-inflammatory cells, activate vascular smooth muscle cell (VSMC) proliferation. Significant changes in the ECM of pulmonary arteries also occurred in vivo in hypoxic rats, namely a decrease in collagen VI and an increase in matrix metalloproteinase 9 (MMP-9) in the tunica media, which may also contribute to the growth activation of VSMCs. The proliferation of VSMCs was also enhanced in their co-culture with macrophages, most likely due to the paracrine production of growth factors in these cells. However, hypoxia itself has a dual effect: on the one hand, it can activate VSMC proliferation and hyperplasia, but on the other hand, it can also induce VSMC hypertrophy and increased expression of contractile markers in these cells. The influence of hypoxia-inducible factors, microRNAs and galectin-3 in the initiation and development of HPH, and the role of cell types other than VSMCs (endothelial cells, adventitial fibroblasts) are also discussed. Keywords: Vasoconstriction, Remodeling, Oxidation, Degradation, Extracellular matrix, Collagen, Proteolytic enzymes, Metalloproteinases, Macrophages, Mast cells, Smooth muscle cells, Endothelial cells, Fibroblasts, Mesenchymal stem cells, Hypoxia-inducible factor, microRNA, Galectins, Hyperplasia, Hypertrophy, Therapy of hypoxic pulmonary hypertension.

• MeSH
• Hypoxia * metabolism   MeSH
• Humans MeSH
• Myocytes, Smooth Muscle * metabolism   pathology   MeSH
• Hypertension, Pulmonary * metabolism   pathology   MeSH
• Cell Proliferation MeSH
• Muscle, Smooth, Vascular * metabolism   pathology   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

OBJECTIVE: The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. METHODS: Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. RESULTS: After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. CONCLUSION: A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1614-1624, 2024.

• MeSH
• Electric Impedance MeSH
• Laryngopharyngeal Reflux * diagnosis   MeSH
• Larynx * MeSH
• Humans MeSH
• Esophageal pH Monitoring MeSH
• Otolaryngologists MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH