BACKGROUND AND OBJECTIVE: While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions. METHODS: In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis. KEY FINDINGS AND LIMITATIONS: We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS. PATIENT SUMMARY: For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance.

• MeSH
• ablace metody   MeSH
• lidé MeSH
• nádory ledvin * chirurgie   mortalita   patologie   MeSH
• nefrektomie * metody   MeSH
• pozorné vyčkávání * MeSH
• tumor burden MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• srovnávací studie MeSH
• systematický přehled MeSH

This study aimed to develop a vancomycin population pharmacokinetic model in obese adult patients treated with intermittent haemodialysis and propose a model-based loading dose strategy ensuring attainment of newly recommended AUC-based PK/PD target. Retrospective cross-sectional analysis was performed among obese haemodialysis dependent adult patients treated with intravenous vancomycin. A pharmacokinetic population model was developed using a nonlinear mixed-effects modelling approach and Monte Carlo simulations were used to identify the optimal loading dose for PK/PD target attainment during the first 48 h of treatment. Therapeutic drug monitoring data from 27 patients with a BMI of 30.2-52.9 kg/m2 were analysed. Among all tested variables, only LBM as a covariate of vancomycin Vd significantly improved the model, while vancomycin CL did not correlate with any of the tested variables. The median (IQR) value from the conditional mean of individual estimates of Vd and CL was 68.4 (56.6-84.2) L and 0.86 (0.79-0.90) L/h, respectively. To ensure optimal vancomycin exposure during the first 48 h of therapy, the vancomycin loading dose of 1500, 1750, 2000, 2250, 2500 and 2750 mg should be administered to obese patients with a lean body mass of ˂50, 50-60, 60-70, 70-80, 80-85 and >85 kg, respectively.

• MeSH
• antibakteriální látky * farmakokinetika   aplikace a dávkování   MeSH
• biologické modely MeSH
• dialýza ledvin * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• metoda Monte Carlo MeSH
• monitorování léčiv MeSH
• obezita * komplikace   MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• vankomycin * farmakokinetika   aplikace a dávkování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Majkić, B, Stojanović, N, Lilić, A, and Milanović, Z. The effects of a 6-week resisted small-sided games training program on the power performance of young soccer players. J Strength Cond Res 39(7): e870-e877, 2025-Small-sided games (SSG) with additional load can improve power performance in soccer players. The purpose of this study was to determine the effects of a 6-week resisted SSG training program on power performance in young soccer players. Twenty-two under-17 top-national youth-level soccer players (age: 16.11 ± 0.41 years; height: 176.31 ± 5.71 cm; body mass: 65.16 ± 8.1 kg) were randomly allocated to a weighted vests group (WV; n = 11), which wore weighted vests of 10% of their body mass or control group (CG; n = 11) with no additional load during sessions. Subjects performed vertical jump test, sprint running test (5, 10, and 30 m), and change of direction tests (COD) (Slalom, t test, and 4 × 5 m). The 6-week experimental program, implemented into regular sessions, included 2 additional SSGs per week and consisted of 3 sets lasting 3 minutes with 3-minute rest intervals. The players were divided into 2 teams of 5 and 2 of 6 players, each consisting of a mix of players from WV and CG, and performed SSG on the field area corresponding to 75 m 2 per player. Results revealed an improvement for WV in jump height by 7.34% (ES = 1.79) and in Peak Power (PP) by 4.40%. Significant interaction effects were observed in the Slalom and 4 × 5 m tests, and there was a distinction for 5 and 30 m sprints but with no statistically significant interaction effects. It is concluded that implementing resisted SSGs during the preparatory period can enhance jump height, PP, COD, and 5 m sprint time in young soccer players.

• MeSH
• běh fyziologie   MeSH
• fotbal * fyziologie   MeSH
• lidé MeSH
• mladiství MeSH
• odporový trénink * metody   MeSH
• sportovní výkon * fyziologie   MeSH
• svalová síla * fyziologie   MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

This study aimed to investigate the effects of performing either eccentric-only (ECC) or eccentric-concentric (ECC-CON) back squats (BS) with a supramaximal load on countermovement jump (CMJ) performance. Changes in front thigh skin surface temperature and mechanical properties (oscillation frequency and stiffness) of the vastus lateralis were also examined. Fourteen male powerlifters participated in this study (age: 22.5 ± 2.3 years, body weight: 84.2 ± 11.1 kg, height: 178 ± 7 cm, training experience: 5.4 ± 1.6 years, BS one-repetition maximum [1RM]: 177 ± 22.8 kg). The experimental sessions included 2 sets of 2 BS at 110% 1RM of either ECC-CON (load distributed by half on the barbell [55%] and on weight releasers [55%]) or ECC (only eccentric phase of BS) and CTRL with no CA applied. CMJ performance, mechanical properties, and skin surface temperature were measured before and at the third, sixth, ninth, and 12th min. After each protocol, only the ECC-CON condition led to a significant increase in CMJ height after individual optimal rest time compared to pre-CA (38.1 ± 5.2 vs. 39.8 ± 5.0 cm; p = 0.003; effect size [ES] = 0.32; Δ = 4.9 ± 5.0%) with a significant rise in skin surface temperature (32.98 ± 1.24 vs. 33.69 ± 0.96°C; p = 0.006; ES = 0.62; Δ = 2.2 ± 2.6%) and no significant changes in mechanical properties of the vastus lateralis. The ECC-CON condition led to a significant acute improvement in CMJ height and an increase in front thigh skin surface temperature among powerlifters. The ECC-CON supramaximal lower limb PAPE protocol should be effectively used among males representing high levels of lower limb muscle strength (>2 × body mass).

• MeSH
• biomechanika MeSH
• čtyřhlavý sval stehenní fyziologie   MeSH
• dospělí MeSH
• kosterní svaly fyziologie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• odporový trénink MeSH
• sportovní výkon * fyziologie   MeSH
• stehno fyziologie   MeSH
• svalová síla fyziologie   MeSH
• teplota kůže * fyziologie   MeSH
• vzpírání * fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The increasing complexity of mass casualty incidents (MCIs) necessitates highly effective training for emergency responders. Traditional training methods, while effective in teaching core skills, often fail to replicate the dynamic, high-pressure environments responders face in real-world crises. Virtual reality (VR) offers a novel approach to emergency training, providing an immersive, controlled setting that can simulate real-life scenarios. This study explores the effectiveness of VR in training paramedic students for MCIs and compares the outcomes to those from conventional training methods. METHODS: A comparative study was conducted with 37 paramedic students who underwent either VR-based training or conventional training using mannequins and real-world equipment. The VR application simulated a mass casualty car accident, focusing on triage and patient management. Both groups were assessed based on their performance in key areas, including the accuracy of situational reporting (METHANE), patient triage, heart rate monitoring, and perceived demand using the NASA Task Load Index (NASA-TLX). RESULTS: The VR group demonstrated significantly lower mental demand (p < 0.001) and frustration levels (p = 0.021) compared to traditional training. However, task completion times were slower in the VR setting (p < 0.001), likely due to the interface's unfamiliarity. Accuracy in situational reporting was higher in VR (p = 0.002), while heart rate monitoring did not reveal a significant difference between the groups (p = 0.516). Although VR did not reduce temporal demand (p = 0.057), it showed potential for improving focus and precision in training. Error rates in triage were similar across both training methods (p = 0.882), indicating comparable performance levels in patient classification. CONCLUSIONS: VR presents a promising tool for training emergency responders, particularly in situations that require rapid upskilling, such as crises or wars. The ability to simulate realistic, high-pressure scenarios in a controlled environment can enhance both cognitive and emotional preparedness. Further research is necessary to optimize VR systems and interfaces, making them more efficient for real-time decision-making. As VR technology advances, it holds potential as a key component in future emergency preparedness strategies.

• MeSH
• dospělí MeSH
• first responder * výchova   psychologie   MeSH
• hromadné neštěstí * MeSH
• lidé MeSH
• plánování postupu v případě katastrof metody   MeSH
• třídění pacientů metody   MeSH
• virtuální realita * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Hypertrofická obstrukční kardiomyopatie (HokmP) je charakterizována ztluštěním stěn a zvětšením masy myokardu nedilatované levé komory srdeční bez vysvětlujících hemodynamických příčin a přítomností gradientu ve výtokovém traktu levé komory (lVoTG). u pacientů s maximální farmakologickou terapií HokmP je indikována invazivní metoda terapie. V minulosti metodou volby k redukci septální hypertrofie byla chirurgická myektomie, kterou vystřídala alkoholová septální ablace (aSa), nyní jde o všeobecně užívanou metodu v redukci septální hypertrofie. V posledních letech se objevila nová nefarmakologická metoda, a to radiofrekvenční ablace mezikomorového septa – v literatuře uváděná jako endocardial radiofrequency ablation of septal hypertrophy (eRaSH). cílem naší kazuistiky je popsat první zkušenosti s touto metodou. Jedná se o třiačtyřicetiletého pacienta s diagnostikovanou HokmP, významným lVoTG a maximální farmakologickou terapií, který podstoupil v roce 2019 alkoholovou septální ablaci pouze s přechodným efektem na regresi lVoTG, a zároveň s nově vzniklou blokádou pravého Tawarova raménka (RBBB). V roce 2021 u pacienta při kontrolní echokradiografii perzistuje vysoká lVoTo až 127 mm Hg a progredující symptomatologie. Proto byla pacientovi navržena eRaSH, se kterou souhlasil. Během výkonu byl mapován a označen převodní systém a hranice ztluštění septa s maximem v blízkosti předního cípu mitrální chlopně s patrným dopředným pohybem předního cípu mitrální chlopně v systole (Sam). Převodní systém byl označen v anatomické mapě body, aby se předešlo jeho poškození. Radiofrekvenční ablace byla zahájena ve střední části ztluštění septa v dostatečné vzdálenosti od převodního systému. Během ablace ale došlo k intermitentní atrioventrikulární blokádě III. stupně, následně ke střídaní bifascikulární blokády charakteru preexistujícího RBBB a levého předního a zadního hemibloku, s následnou restitucí do atrioventrikulární (aV) blokády Wenckebach 3 : 2, ablace byla pro riziko poškození převodního systému ukončena. Po výkonu bylo provedeno kontrolní měření lVoTG, který dosahoval 3,1 mm Hg, po komorové extrasystole 84,4 mm Hg. Během následujících hodin došlo k restituci aV vedení, 12 hodin po výkonu byl na povrchovém ekG patrný sinusový rytmus s aV blokádou I. stupně a RBBB bez převodní poruchy vyššího stupně, na dalších kontrolách po současnost je pacient bez převodních poruch rytmu a s trvajícím nízkým gradientem v lVoT. Pacienti s RBBB po předchozí aSa se jeví jako suboptimální kandidáti eRaSH vzhledem k vysokému riziku vzniku blokády levého Tawarova raménka během výkonu eRaSH a následné kompletní aV blokády. Při eRaSH v terénu předchozí aSa mohou vznikat bizarní poruchy aV převodu jako v níže popsané kazuistice.

Hypertrophic obstructive cardiomyopathy (HOCMP) is characterized by abnormal thickening or enlargement of the left ventricular myocardium mass of non-dilated left ventricle not explained solely by loading conditions and presence of obstruction in outflow tract of left ventricle. Surgical septal myectomy was the first choice method of invasive treatment of septal hypertrophy in the past which was replaced by alcohol septal ablation in the nineties of the 20th century and nowadays it is still worldwide used, safe, and effective method in reduction of septal hypertrophy. Nowadays there is a new method of non-pharmacological treatment of septal hypertrophy which is endocardial radiofrequency ablation of septal hypertrophy (ERASH). Main goal of our case report is to describe first experiences with ERASH method in our department. A forty- -three-year-old patient with diagnosed HOCMP and severe left ventricle outflow tract gradient (LVOTG) despite maximal pharmacological treatment who underwent alcohol septal ablation (ASA) in 2019, only with transient effect on LVOTG, and the new onset of right bundle branch block (RBBB). In 2021, there was still high LVOTG present on echocardiography - 127 mmHg and progressive symptomatology. The patient agreed to undergo ERASH. Hypertrophic part of septum and conduction system have been mapped and marked to avoid destruction. Radiofrequency ablation was started in the middle part of septal hypertrophy in safe distance from conduction system, however, during ablation there was a sudden onset of atrioventri- cular block of third degree, forwarded with alternating bifascicular block RBBB and left anterior or posterior hemiblock, with restitution to AV block of the second degree 3 : 2. Ablation was terminated at this point because of risk of harming conduction system. Immediate measurements straight after procedure were LVOTG 3.1 mmHg at rest and 84.4 mmHg after ventricle extrasystole. In next hours there was a restitution of conduction system to AVB of the first degree with preexisting RBBB. Nowadays the patient is without any conduction disorders of higher degree and low LVOTG still lasts. The patients after alcohol septal ablation with preexisting RBBB seem to be inappropriate candidates for ERASH procedure due to high risk of conduction disorders of higher degree as was seen in our case report.

• MeSH
• dospělí MeSH
• echokardiografie MeSH
• hypertrofická kardiomyopatie * chirurgie   patologie   MeSH
• katetrizační ablace * metody   přístrojové vybavení   škodlivé účinky   MeSH
• lidé MeSH
• obstrukce výtokového traktu levé komory srdeční chirurgie   etiologie   patologie   MeSH
• srdeční arytmie etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

Orthotopic tumor models in pre-clinical translational research are becoming increasingly popular, raising the demands on accurate tumor localization prior to irradiation. This task remains challenging both in x-ray and proton computed tomography (xCT and pCT, respectively), due to the limited contrast of tumor tissue compared to the surrounding tissue. We investigate the feasibility of gadolinium oxide nanoparticles as a multimodal contrast enhancement agent for both imaging modalities. We performed proton radiographies at the experimental room of the Trento Proton Therapy Center using a MiniPIX-Timepix detector and dispersions of gadolinium oxide nanoparticles in sunflower oil with mass fractions up to 8wt%. To determine the minimum nanoparticle concentration required for the detectability of small structures, pCT images of a cylindrical water phantom with cavities of varying gadolinium oxide concentration were simulated using a dedicated FLUKA Monte Carlo framework. These findings are complemented by simulating pCT at dose levels from 80 mGy to 320 mGy of artificially modified murine xCT data, mimicking different levels of gadolinium oxide accumulation inside a fictitious tumor volume. To compare the results obtained for proton imaging to x-ray imaging, cone-beam CT images of a cylindrical PMMA phantom with cavities of dispersions of oil and gadolinium oxide nanoparticles with mass fractions up to 8wt% were acquired at a commercial pre-clinical irradiation setup. For proton radiography, considerable contrast enhancement was found for a mass fraction of 4wt%. Slightly lower values were found for the simulated pCT images at imaging doses below 200 mGy. In contrast, full detectability of small gadolinium oxide loaded structures in xCT at comparable imaging dose is already achieved for 0.5wt%. Achieving such concentrations required for pCT imaging inside a tumor volume inin-vivoexperiments may be challenging, yet it might be feasible using different targeting and/or injection strategies.

• MeSH
• fantomy radiodiagnostické * MeSH
• gadolinium * chemie   MeSH
• kontrastní látky * chemie   MeSH
• myši MeSH
• nanočástice * chemie   MeSH
• počítačová rentgenová tomografie MeSH
• protony * MeSH
• zvířata MeSH
• Check Tag
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Although the effects of carrying loads on gait biomechanics have been well-documented, to date, little evidence has been provided whether such loads may impact spatial and temporal gait asymmetries under the different foot regions. Therefore, the main purpose of the study was to examine the effects of carrying a standardized police equipment on spatiotemporal gait parameters. MATERIALS AND METHODS: In this population-based study, participants were 845 first-year police recruits (age: 21.2 ± 2.3 years; height: 178.1 ± 10.2 cm; weight: 78.4 ± 11.3 kg; body mass index: 24.7 ± 3.2 kg/m2; 609 men and 236 women; 72.1% men and 27.9% women) measured in 2 conditions: (i) "no load" and (ii) "a 3.5 kg load." Spatiotemporal gait parameters were derived from the FDM Zebris pressure platform. Asymmetry was calculated as (xright-xleft)/0.5*(xright + xleft)*100%, where "x" represented a given parameter being calculated and a value closer to 0 denoted greater symmetry. RESULTS: When compared to "no load" condition, a standardized 3.5 kg/7.7 lb load significantly increased asymmetries in spatial gait parameters as follows: gait phases of stance (mean diff. = 1.05), load response (mean diff. = 0.31), single limb support (mean diff. = 0.56), pre-swing (mean diff. = 0.22), and swing (mean diff. = 0.90) phase, while no significant asymmetries in foot rotation, step, and stride length were observed. For temporal gait parameters, we observed significant asymmetries in step time (mean diff. = -0.01), while no differences in cadence and gait speed were shown. CONCLUSIONS: The findings indicate that the additional load of 3.5 kg/7.7 lb is more likely to increase asymmetries in spatial gait cycle components, opposed to temporal parameters. Thus, external police load may have hazardous effects in increasing overall body asymmetry, which may lead to a higher injury risk and a decreased performance for completing specific everyday tasks.

• MeSH
• biomechanika fyziologie   MeSH
• chůze (způsob) * fyziologie   MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• policie * statistika a číselné údaje   MeSH
• zatížení muskuloskeletálního systému * fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Background: The tempo of resistance exercises is known to influence performance outcomes, yet its specific effects on post-activation performance enhancement (PAPE) remain unclear. This study aimed to investigate the effects of fast versus slow repetitions at a load of 70% of one-repetition maximum (1-RM) in the bench press exercise, focusing on velocity, surface electromyographic (sEMG) activity, and applied force while equating time under tension on bench press throw performance. Methods: Eleven men (age: 23.5 ± 5.4 years, height: 1.79 ± 0.04 m, body mass: 79.1 ± 6.4 kg, maximum strength 1-RM: 91.0 ± 12.0 kg) participated. Two experimental conditions (FAST and SLOW) and one control (CTRL) were randomly assigned. Participants performed two sets of six repetitions as fast as possible (FAST condition) and two sets of three repetitions at a controlled tempo (SLOW condition) at half the concentric velocity of FAST, as determined in a preliminary session. Before and after the bench press participants performed bench press throws tests (Pre, 45 s, 4, 8, and 12 min after). Results: sEMG activity and peak force during the bench press were higher in FAST vs. SLOW conditioning activity (p < 0.001), with time under tension showing no significant differences between conditions (p > 0.05). Mean propulsive velocity (MPV) during the bench press throw improved equally in both FAST and SLOW conditions compared with baseline from the 4th to the 12th min of recovery (FAST: +6.8 ± 2.9% to +7.2 ± 3.3%, p < 0.01, SLOW: +4.0 ± 3.0% to +3.6 ± 4.5%, p < 0.01, respectively). Compared to the CTRL, both conditions exhibited improved MPV values from the 4th to 12th min (p < 0.01). Peak velocity improvements were observed only after the FAST condition compared to the baseline (p < 0.01) with no differences from SLOW. For all muscles involved and time points, sEMG activity during bench press throws was higher than CTRL in both experimental conditions (p < 0.01), with no differences between FAST and SLOW. Peak force increased in both FAST and SLOW conditions at all time points (p < 0.05), compared to CTRL. Conclusions: These findings suggest that post-activation performance enhancement is independent of movement tempo, provided that the resistive load and total time under tension of the conditioning activity are similar. This study provides valuable insights into the complex training method for athletes by demonstrating that varying tempo does not significantly affect post-activation performance enhancement when load and TUT are equated.

• Publikační typ
• časopisecké články MeSH

A sedentary lifestyle, characterised by a lack of physical activity, negatively influences Body Mass Index (BMI). BMI may be related to the prevalence of flat feet. This study aims to observe the occurrence of flat feet in young children and determine its association with BMI. Additionally, it aims to analyse foot loading in the forefoot, midfoot and rearfoot. Dynamographic records of children (N = 142; age = 10.3 ± 0.21 years) were collected during walking, and foot-type evaluations were conducted using a force plate. A normal foot type was observed in 44% of children (BMI 16.0 ± 2.3 kg/m2). Flat feet were observed in 54% of children (BMI 18.4 ± 4.3 kg/m2). A high foot arch was observed in only 2% of children (BMI 16.0 ± 1.3 kg/m2). Children with flat feet had higher BMI values than those with normal feet. The contact time and maximal vertical force in the forefoot and rearfoot were similar in children with normal and flat feet. Significantly higher pressure values were observed in the midfoot zone of children with flat feet. Regression analysis results showed that in children with flat feet, there is a decrease in forefoot loading and an increase in midfoot loading with increasing BMI. This trend was not observed in children with normal feet. We recommend incorporating exercise interventions at this age to prevent pain and promote willingness to engage in physical activity. Higher BMI values indicate an increased risk for the prevalence of flat feet.

• MeSH
• chůze fyziologie   MeSH
• dítě MeSH
• index tělesné hmotnosti * MeSH
• lidé MeSH
• noha (od hlezna dolů) fyziologie   anatomie a histologie   MeSH
• plochá noha * epidemiologie   MeSH
• sedavý životní styl MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH