INTRODUCTION AND OBJECTIVES: With increases in obesity and metabolic syndrome because of lifestyle-related factors, the prevalence of non-alcoholic fatty liver disease (NAFLD) also is increasing worldwide. In a subset of patients with NAFLD, an inflammatory process arises in the steatotic liver, known as non-alcoholic steatohepatitis, that leads to liver fibrosis and liver cirrhosis. In selected patients with obesity, bariatric surgery, and bariatric endoscopy are important therapeutic options. MATERIALS AND METHODS: This prospective interventional pilot study was conducted to investigate two types of intragastric balloons (IGB). The IGBs were the Orbera and the Spatz3. Liver fibrosis changes were monitored non-invasively using point and 2D shear wave ultrasound elastography (SWE) and transient elastography that allowed for quantification of liver steatosis using the controlled attenuation parameter (CAP). Patients were followed for 12 months. RESULTS: Of 34 patients implanted with an IGB, 30 completed follow-up at month 12; results for one patient were excluded because of initiation of obesity pharmacotherapy. Fifteen patients received the Orbera IGB, and nineteen patients received the Spatz3 type. In month 12, total and excess weight loss was 7.88 % and 30.13 %. Elastography values decreased from baseline (3.88 kPa) to 3.61 kPa at month 12 (p 0.024). 2D SWE values decreased from baseline (5.42 kPa) to a value of 4.91 kPa at month twelve (p 0.135). Transient elastography values decreased from baseline (5.62 kPa) to a value of 4.17 kPa at month twelve (p 0.009). CONCLUSIONS: Bariatric endoscopy in the form of IGB implantation leads to weight reduction and improvement of liver fibrosis and steatosis. GOV REGISTRATION: NCT04895943.

• MeSH
• Bariatric Surgery * MeSH
• Time Factors MeSH
• Equipment Design MeSH
• Adult MeSH
• Elasticity Imaging Techniques MeSH
• Weight Loss MeSH
• Liver Cirrhosis * etiology   diagnostic imaging   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Non-alcoholic Fatty Liver Disease * diagnostic imaging   diagnosis   etiology   MeSH
• Obesity * complications   surgery   diagnosis   MeSH
• Pilot Projects MeSH
• Prospective Studies MeSH
• Treatment Outcome MeSH
• Gastric Balloon * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH

Introduction: Venipuncture is a standard invasive procedure in children that causes pain, leading to procedural anxiety. It emphasises the clinical importance of adequate analgesia and the need to identify effective non-pharmacological procedures. Goal: This study primarily aims to comparatively evaluate the analgesic efficacy of four nonpharmacological interventions: Buzzy ® vibrating device, local cooling, felinotherapy, and oral stimulation with a lollipop – compared to standard care (control group) in children aged 4–11 years undergoing venipuncture. The secondary goal was to compare the assessment of pain intensity by the child and the parent. Methods: A prospective five-arm randomised controlled trial included 125 children (25 in each arm). The child and the parent assessed pain intensity immediately after the procedure using the Wong–Baker face scale (WBF 0–5). One-factor analysis of variance (ANOVA) with post-hoc Tukey’s test (α = 0.05) was used to compare the mean values of the Wong–Baker face scale between groups. Results: The Buzzy® device showed the lowest average pain value according to the children (WBF 1.96 ± 0.90) and was significantly more effective than the lollipop and the control group (p < 0.05). Local cooling (WBF 2.50 ± 1.16) was the second most effective method. The effect of felinotherapy (WBF 2.71 ± 1.16) was not statistically different from the control group (WBF 2.96 ± 1.31). Oral stimulation with a lollipop (WBF 3.79 ± 1.08) was the least effective. According to their perception, parents systematically underestimated children’s pain (average difference in WBF –0.96 points). Neither the age nor the gender of the children influenced the effectiveness of the interventions. Conclusion: Buzzy ® vibrating device is the most effective researched non-pharmacological intervention for reducing pain during venipuncture in children aged 4–11 years. Local cooling is also an effective and affordable alternative.

AIM: Percutaneous transthoracic needle biopsy (PTNB), an alternative to bronchoscopic confirmation of lung lesions, is today being associated with a risk of pneumothorax and hemorrhage. Further, there are no data on the possible risk of malignant disease spreading to the pleura at the site of the PTNB. Previous studies have dealt with this risk in stage I non-small cell lung cancer only. The aim of this study was thus to assess the risk of pleural recurrence for all types of lung lesions. Secondary objectives included assessment of diagnostic yield and safety with respect to the incidence of pneumothorax and hemorrhage. METHODS: Clinical data of all patients from the University Hospital in Pilsen who had undergone PTNB of lung lesions between 1.1.2018 and 31.12.2022 were included in this retrospective study. RESULTS: Following PTNB, ipsilateral pleural effusion occurred in 4.8% of patients without prior pleural infiltration. The effusion was confirmed as malignant in one patient (0.7%). Diagnostic yield of the method was 86.6%. We recorded pneumothorax or hemorrhage in the lung parenchyma or pleural space requiring medical intervention in 3.4% and 1.1% of patients, respectively. CONCLUSION: In our study, percutaneous transthoracic needle biopsy of lung lesions showed high sensitivity and low degree of acute complications requiring an invasive solution. The risk of pleural recurrence after a biopsy was very low. Consequently, we continue to consider this method to be an alternative to bronchoscopy biopsies.

• MeSH
• Adult MeSH
• Biopsy, Needle adverse effects   methods   MeSH
• Hemorrhage etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lung Neoplasms * pathology   MeSH
• Pleural Effusion etiology   pathology   MeSH
• Lung pathology   MeSH
• Pneumothorax * etiology   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Pierre Robinova sekvence (PRS) je vrozená vada, která zahrnuje mikrognatii, glosoptózu a u části pacientů rovněž rozštěp patra různého rozsahu. To vede k obstrukci horních dýchacích cest a problémům s krmením. PRS vyžaduje komplexní přístup, který kombinuje multidisciplinární péči a využívá jak chirurgické, tak neinvazivní metody. V posledních letech se jako jedna z hlavních neinvazivních možností léčby prosazuje Tübingenská palatinální destička (TPP), která stabilizuje polohu jazyka a pomáhá eliminovat obstrukci dýchacích cest. Současně uvolněním a předsunutím jazyka také stimuluje růst dolní čelisti a výrazně zlepšuje krmení novorozenců, čímž snižuje potřebu chirurgických zákroků, jako je např. tracheostomie. Tato metoda je nyní dostupná na specializovaných pracovištích v ČR, včetně Pediatrické kliniky 2. LF UK a FN Motol ve spolupráci se Stomatologickou klinikou 3. LF UK a FN KV Praha a s Rozštěpovým centrem Praha FN KV a Centrem pro léčbu rozštěpů obličeje v Brně. Významnou roli v péči o pacienty s PRS hraje multidisciplinární tým složený z pediatrů, ORL specialistů, plastických a maxilofaciálních chirurgů, ortodontistů a logopedů, který zajišťuje optimalizaci léčby a prevenci komplikací. Tento článek se zaměřuje na dostupné možnosti léčby PRS v České republice a zdůrazňuje přínosy TPP i nové technologie, jako je 3D tisk, které umožňují přesně přizpůsobené pomůcky pro efektivní léčbu.

Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and, in some patients, cleft palate of varying extent. This leads to upper airway obstruction and feeding difficulties. PRS requires a comprehensive approach that combines multidisciplinary care with both surgical and non-invasive methods. In recent years, the Tübingen Palatal Plate (TPP) has emerged as one of the primary non-invasive treatment options. TPP stabilizes the tongue position, helping to eliminate airway obstruction. Additionally, by relieving and advancing the tongue, it stimulates mandibular growth and significantly improves feeding in newborns, reducing the need for surgical interventions such as tracheostomy. This method is now available at specialized centers in the Czech Republic, including the Pediatric Department of the 2nd Faculty of Medicine, Charles University and University Hospital Motol, in collaboration with the Dental Department of the 3rd Faculty of Medicine, Charles University and FN KV Prague, and with Prague Cleft Center at FN KV, and the Facial Cleft Treatment Center in Brno. A multidisciplinary team plays a vital role in the care of PRS patients, comprising pediatricians, ENT specialists, plastic and maxillofacial surgeons, orthodontists, and speech therapists. This team ensures treatment optimization and prevents complications. This article focuses on the available treatment options for PRS in the Czech Republic, highlighting the benefits of TPP and new technologies, such as 3D printing, which allow for precisely tailored devices to enhance treatment efficacy.

• MeSH
• Glossoptosis therapy   MeSH
• Humans MeSH
• Airway Obstruction MeSH
• Orthodontic Appliances MeSH
• Pierre Robin Syndrome * diagnosis   etiology   therapy   MeSH
• Cleft Palate therapy   MeSH
• Patient Care Team MeSH
• Check Tag
• Humans MeSH

Velký rozvoj a zlepšení výsledků konzervativní léčby u pacientů s asymptomatickými stenózami krkavice v posledních letech nastartoval diskuzi o optimální invazivní léčbě, v některých případech se dokonce diskutovalo a nadále diskutuje i o její potřebnosti. Několik studií, jejichž cílem bylo najít nejvýhodnější přístup pro bezpříznakové pacienty se stenózami krkavic již proběhlo, u jiných ještě randomizace probíhá a na výsledky se čeká. Zásadní nezodpovězenou otázkou je, zda má revaskularizace větší přínos než intenzivní konzervativní léčba, zejména vzhledem k nižšímu počtu cévních mozkových příhod, kterých se dosahuje bez klasické nebo endovaskulární intervence v posledních letech. Dlouhodobým cílem by měla být identifikace takové podskupiny pacientů, která by profitovala z konzervativního postupu. V tomto textu shrnujeme problematiku v kontextu dosavadních výsledků dvou čerstvě ukončených zásadních studií.

In recent years, the significant progress in the outcomes of conservative treatment for patients with asymptomatic carotid stenosis has sparked discussions about the most effective invasive treatment. The necessity of such treatment is still being debated in certain cases. Several studies have already been conducted to find the most appropriate approach for asymptomatic patients with carotid stenosis, while others are still randomizing and awaiting results. A major unanswered question is whether revascularization is more beneficial than intensive conservative treatment, particularly in view of the lower stroke rates achieved in recent years without conventional or endovascular intervention. The long-term goal should be to identify a subset of patients who would benefit from conservative treatment. In this text, we summarize the issue in the context of the results of two recently completed pivotal studies.

• Keywords
• studie SPACE-2, studie ACST-2,
• MeSH
• Asymptomatic Diseases * MeSH
• Stroke etiology   prevention & control   MeSH
• Endarterectomy, Carotid MeSH
• Conservative Treatment MeSH
• Humans MeSH
• Multicenter Studies as Topic MeSH
• Randomized Controlled Trials as Topic MeSH
• Carotid Stenosis * surgery   complications   therapy   MeSH
• Stents MeSH
• Check Tag
• Humans MeSH

Conflict deeply affects human experiences, frequently testing individual resilience to its breaking point and leaving enduring psychological and societal wounds. The current conflict in Ukraine, initiated by Russia's invasion in 2022, illustrates this phenomenon by altering regional relationships and triggering a major humanitarian crisis marked by extensive displacement, loss of life, and emotional turmoil. This study explores the factors influencing hope and distress in Ukraine alongside six nearby European countries during the ongoing conflict. A cross-sectional survey collected data primarily via internet panel samples from the Czech Republic, Georgia, Lithuania, Poland, Romania, Slovakia, and Ukraine in the second year since the war's initiation. The current study utilised validated instruments, collecting data on levels of hope, distress, individual resilience, community resilience, societal resilience, morale, sense of danger, perceived security threats, and demographic characteristics. Hope and distress levels differ across countries, with Ukraine exhibiting the highest levels of both (3.74 ± 1.02 and 2.89 ± 0.87, respectively). Overall, average scores of hope were higher than average distress levels. Across the regression models for the seven countries, hope showed strong associations with individual (between β = 0.089 and β = 0.327) and societal resilience (between β = 0.206 and β = 0.514), while morale (between β = -0.104 and β = -0.479) and individual resilience (between β = -0.077 and β = -0.335) displayed a protective relationship against distress (all β values were significant, p < 0.01). Monitoring hope and distress is crucial during the Russian-Ukrainian war and other adversities, as these factors give insight into the current and future psychological states of affected populations. The results offer valuable information that can guide the development of tailored strategies to enhance hope and buffer distress in war-impacted countries, as well as those experiencing its broader effects. Fostering individual and societal resilience, alongside enhancing morale, may strengthen hope and mitigate distress amid adversity. Developing targeted interventions that address each population's unique needs, as well as their sociocultural and geopolitical contexts can enhance efficacy.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Hope * MeSH
• Armed Conflicts * psychology   MeSH
• Cross-Sectional Studies MeSH
• Resilience, Psychological * MeSH
• Psychological Distress * MeSH
• Stress, Psychological * psychology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Russia MeSH
• Ukraine MeSH

The IgM-related peripheral neuropathies (IgM-PN) are a group of chronic disorders characterized by the presence of monoclonal IgM that may be associated with one of several diseases affecting the peripheral nerves. In many cases, there is a monoclonal IgM associated with activity against neural targets, leading to progressive peripheral nerve demyelination. Neurological symptoms in this setting can also result from direct invasion of the peripheral or central nervous system by lymphoplasmacytic cells (neurolymphomatosis and Bing-Neel syndrome respectively) or via other mechanisms (for example AL amyloid deposition or cryoglobulinemic vasculitis). There is an expanding array of treatment options, but high-quality data are sparse. Diagnostic accuracy is important and needs collaboration between hematologists and neuromuscular specialists to determine the sequence and intensity of investigations. Appropriate causal attribution to the IgM disorder is essential to enable the correct therapeutic intervention. The aims of treatment intervention should be clear and realistic. Consistent and clinically meaningful measures are needed to capture treatment success. Despite therapeutic advances, many patients experience persistent disability, highlighting the need for further research.

• MeSH
• Immunoglobulin M * immunology   MeSH
• Humans MeSH
• Disease Management MeSH
• Peripheral Nervous System Diseases * therapy   diagnosis   etiology   immunology   MeSH
• Waldenstrom Macroglobulinemia * therapy   complications   diagnosis   immunology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH

Digestivní endoskopie, klíčová metoda pro diagnostiku a léčbu onemocnění gastrointestinálního traktu, se neustále vyvíjí. Novinky v této oblasti zahrnují pokroky v technologii, nové diagnostické techniky a inovace v terapeutických přístupech. Moderní endoskopická zařízení nyní nabízejí vyšší rozlišení obrazu díky pokročilé optice a kamerovým systémům, což umožňuje lépe identifikovat a charakterizovat patologické změny v gastrointestinálním traktu. Nový vývoj technik jako je endoskopická ultrasonografie (EUS), rozšiřuje možnosti diagnostiky tím, že umožňuje vizualizaci hloubkových struktur a vyšetření okolních tkání. Cholangioskopie vhodně doplňuje endoskopickou retrográdní cholangiopankreatikografii (ERCP) v diagnostice biliárních stenóz nejasné etiologie a umožňuje jejich cílenou biopsii. Enteroskopie přinesla významné rozšíření diagnostických a terapeutických postupů zaměřených na tenké střevo. V terapeutických přístupech zaznamenáváme rozvoj minimálně invazivních metod, které umožňují odstranění lézí a léčbu různých gastrointestinálních onemocnění bez nutnosti otevřené chirurgické intervence. Tyto inovace nejen zvyšují přesnost diagnostiky, ale také rozšiřují možnosti léčby, čímž přispívají k lepší péči o pacienty. Budoucnost digestivní endoskopie bude pravděpodobně zaměřena na další zlepšení endoskopických technik s cílem optimalizovat výsledky a minimalizovat invazivitu, a také využití umělé inteligence.

Digestive endoscopy, a key method for the diagnosis and treatment of diseases of the gastrointestinal tract, is constantly evolving. New developments in this field include advances in technology, new diagnostic techniques, and innovations in therapeutic approaches. Modern endoscopic equipment now offers higher image resolution thanks to advanced optics and camera systems, which allow better identification and characterization of pathological changes in the gastrointestinal tract. New techniques, such as endoscopic ultrasonography (EUS), are expanding diagnostic capabilities by allowing visualization of deep structures and examination of surrounding tissues. Cholangioscopy appropriately complements endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of biliary strictures of uncertain etiology and allows their targeted biopsy. Enteroscopy has brought a significant extension of diagnostic and therapeutic procedures targeting the small intestine. In therapeutic approaches, we have seen the development of minimally invasive methods that allow the removal of lesions and the treatment of various gastrointestinal diseases without the need for open surgical intervention. These innovations not only increase the accuracy of diagnosis but also expand treatment options, thus contributing to better patient care. The future of digestive endoscopy will likely focus on further improvements in endoscopic techniques to optimize outcomes and minimize invasiveness.

• MeSH
• Endoscopic Mucosal Resection methods   instrumentation   MeSH
• Endoscopy, Digestive System * classification   methods   instrumentation   MeSH
• Endosonography classification   methods   MeSH
• Endoscopy, Gastrointestinal classification   methods   MeSH
• Humans MeSH
• Digestive System Diseases * diagnostic imaging   pathology   therapy   MeSH
• Bile Ducts diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Precise localization of the epileptogenic zone is pivotal for planning minimally invasive surgeries in drug-resistant epilepsy. Here, we present a graph neural network (GNN) framework that integrates interictal intracranial EEG features, electrode topology, and MRI features to automate epilepsy surgery planning. We retrospectively evaluated the model using leave-one-patient-out cross-validation on a dataset of 80 drug-resistant epilepsy patients treated at St. Anne's University Hospital (Brno, Czech Republic), comprising 31 patients with good postsurgical outcomes (Engel I) and 49 with poor outcomes (Engel II-IV). The GNN predictions demonstrated a significantly better (P < 0.05, Mann-Whitney-U test) area under the precision-recall curve in patients with good outcomes (area under the precision-recall curve: 0.69) compared with those with poor outcomes (area under the precision-recall curve: 0.33), indicating that the model captures clinically relevant targets in successful cases. In patients with poor outcomes, the graph neural network proposed alternative intervention sites that diverged from the original clinical plans, highlighting its potential to identify alternative therapeutic targets. We show that topology-aware GNNs significantly outperformed (P < 0.05, Wilcoxon signed-rank test) traditional neural networks while using the same intracranial EEG features, emphasizing the importance of incorporating implantation topology into predictive models. These findings uncover the potential of GNNs to automatically suggest targets for epilepsy surgery, which can assist the clinical team during the planning process.

• Publication type
• Journal Article MeSH

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder that significantly affects quality of life. Conventional treatment approaches include pharmacological interventions, physical therapy, and procedures such as dry needling. Among these, ultrasound-guided injections (USGIs) have gained recognition for their precision and therapeutic benefits. Additionally, repetitive peripheral magnetic stimulation (rPMS) has emerged as a non-invasive neuromodulatory technique for pain management. This perspective article examines the physiological mechanisms and clinical applications of USGIs and rPMS, particularly in the lumbar multifidus muscle, and explores their potential synergistic effects. MPS is often associated with chronic muscle dysfunction due to energy depletion, leading to persistent pain and motor impairment. USGIs play a crucial role in restoring muscle perfusion, disrupting pain cycles, and providing diagnostic insights in real time. In parallel, rPMS modulates neuromuscular activation, enhances endogenous pain control, and promotes functional recovery. Ultrasound guidance enhances the precision and effectiveness of interventions, such as dry needling, interfascial plane blocks, and fascial hydrodissection, while rPMS complements these strategies by facilitating neuromuscular reconditioning and reducing pain via central and peripheral mechanisms. The preliminary findings suggest that combining multifidus USGIs with rPMS results in significant pain relief and functional improvements in patients with chronic low back pain. Integrating USGIs with rPMS represents a promising multimodal strategy for managing MPS. By combining targeted injections with non-invasive neuromodulation, clinicians may optimize therapeutic outcomes and provide sustained relief for patients with chronic musculoskeletal pain. Further research is needed to refine treatment protocols and assess the long-term efficacy.

• Publication type
• Journal Article MeSH