INTRODUCTION: The histopathological classification for antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (ANCA-GN) is a well-established tool to reflect the variety of patterns and severity of lesions that can occur in kidney biopsies. It was demonstrated previously that deep learning (DL) approaches can aid in identifying histopathological classes of kidney diseases; for example, of diabetic kidney disease. These models can potentially be used as decision support tools for kidney pathologists. Although they reach high prediction accuracies, their "black box" structure makes them nontransparent. Explainable (X) artificial intelligence (AI) techniques can be used to make the AI model decisions accessible for human experts. We have developed a DL-based model, which detects and classifies the glomerular lesions according to the Berden classification. METHODS: Kidney biopsy slides of 80 patients with ANCA-GN from 3 European centers, who underwent a diagnostic kidney biopsy between 1991 and 2011, were included. We also investigated the explainability of our model using Gradient-weighted Class Activation Mapping (Grad-CAM) heatmaps. These maps were analyzed by pathologists to compare the decision-making criteria of humans and the DL model and assess the impact of different training settings. RESULTS: The DL model shows a prediction accuracy of 93% for classifying lesions. The heatmaps from our trained DL models showed that the most predictive areas in the image correlated well with the areas deemed to be important by the pathologist. CONCLUSION: We present the first DL-based computational pipeline for classifying ANCA-GN kidney biopsies as per the Berden classification. XAI techniques helped us to make the decision-making criteria of the DL accessible for renal pathologists, potentially improving clinical decision-making.

• Publikační typ
• časopisecké články MeSH

PURPOSE OF REVIEW: A critical evaluation of contemporary literature regarding the role of big data, artificial intelligence, and digital technologies in precision cardio-oncology care and survivorship, emphasizing innovative and groundbreaking endeavors. RECENT FINDINGS: Artificial intelligence (AI) algorithm models can automate the risk assessment process and augment current subjective clinical decision tools. AI, particularly machine learning (ML), can identify medically significant patterns in large data sets. Machine learning in cardio-oncology care has great potential in screening, diagnosis, monitoring, and managing cancer therapy-related cardiovascular complications. To this end, large-scale imaging data and clinical information are being leveraged in training efficient AI algorithms that may lead to effective clinical tools for caring for this vulnerable population. Telemedicine may benefit cardio-oncology patients by enhancing healthcare delivery through lowering costs, improving quality, and personalizing care. Similarly, the utilization of wearable biosensors and mobile health technology for remote monitoring holds the potential to improve cardio-oncology outcomes through early intervention and deeper clinical insight. Investigations are ongoing regarding the application of digital health tools such as telemedicine and remote monitoring devices in enhancing the functional status and recovery of cancer patients, particularly those with limited access to centralized services, by increasing physical activity levels and providing access to rehabilitation services. SUMMARY: In recent years, advances in cancer survival have increased the prevalence of patients experiencing cancer therapy-related cardiovascular complications. Traditional cardio-oncology risk categorization largely relies on basic clinical features and physician assessment, necessitating advancements in machine learning to create objective prediction models using diverse data sources. Healthcare disparities may be perpetuated through AI algorithms in digital health technologies. In turn, this may have a detrimental effect on minority populations by limiting resource allocation. Several AI-powered innovative health tools could be leveraged to bridge the digital divide and improve access to equitable care.

• Publikační typ
• časopisecké články MeSH

Pancreas is a vital gland of gastrointestinal system with exocrine and endocrine secretory functions, interweaved into essential metabolic circuitries of the human body. Pancreatic ductal adenocarcinoma (PDAC) represents one of the most lethal malignancies, with a 5-year survival rate of 11%. This poor prognosis is primarily attributed to the absence of early symptoms, rapid metastatic dissemination, and the limited efficacy of current therapeutic interventions. Despite recent advancements in understanding the etiopathogenesis and treatment of PDAC, there remains a pressing need for improved individualized models, identification of novel molecular targets, and development of unbiased predictors of disease progression. Here we aim to explore the concept of precision medicine utilizing 3-dimensional, patient-specific cellular models of pancreatic tumors and discuss their potential applications in uncovering novel druggable molecular targets and predicting clinical parameters for individual patients.

• MeSH
• duktální karcinom slinivky břišní * patologie   genetika   metabolismus   MeSH
• individualizovaná medicína * metody   MeSH
• lidé MeSH
• nádory slinivky břišní * patologie   genetika   MeSH
• techniky 3D buněčné kultury metody   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Background/Objectives: Hip and knee arthroplasty relieves pain, restores mobility, and improves function in severe joint damage, though pain and strength loss may persist post-surgery. Better pre-surgery function and activity predict improved arthroplasty outcomes. Prehabilitation programs enhance functional abilities, reducing hospitalization duration, and lowering peri-surgery complication risks. This study aims to evaluate the efficacy of four weeks of different modalities of tele-home-prehabilitation programs on perceived pain and functional capacity in patients who are eligible for hip or knee arthroplasty. Methods: Forty-four patients (aged 65-80 years) eligible for elective lower limb arthroplasty were enrolled in the present randomized controlled trial study. Participants were randomly assigned to the Electrostimulation Group (EG) or the Home-Based Exercise Group (HG). The EG performed underwent teleprehabilitation program using indirect neuromuscular electrostimulation therapy, while the HG performed home-based exercise supervised by a sports specialist. Functional capacity was assessed with the Timed Up and Go test (TUG), the 30 s Chair Stand test (30CST) and the Six-Minute Walking Test (6MWT). Quality of life was assessed with the Oxford Hip Score (OHS) or Oxford Knee Score (OKS), depending on the participants' surgery. The Technology Acceptance Model (TAM) questionnaire was completed by the EG after the intervention. Results: No significant differences were found among groups in the 30CST and TUG tests. The analyses revealed significant differences for the Oxford Questionnaires and 6MWT. Conclusions: Our study highlights the potential of teleprehabilitation using indirect neuromuscular electrostimulation to improve walking autonomy and quality of life of individuals who are candidates for lower limb arthroplasty.

• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Problematic online video pornography consumption is associated with sexual objectification, particularly in male consumers. However, previous studies have not considered that there is a subgroup of internet users whose consumption may become problematic due to their internet sex addiction. Such users may, in response to internet sex addiction symptoms such as craving, have increased levels of sexual objectification. METHODS: In a sample of 1,272 male consumers of online video pornography (Mage = 32.93, SDage = 9.44), we examined whether internet sex addiction is linked to sexual objectification via an online survey. RESULTS: We fitted a series of structural equation models and found that men who scored higher on internet sex addiction were more likely to objectify women. More importantly, this link did not cease when controlling for the frequency of online video pornography consumption. DISCUSSION: Our findings suggest that there are other mechanisms related to addictive symptomatology than just the link through online video pornography consumption that may contribute to sexual objectification. Addiction-related factors may have a unique role in fostering sexual objectification. Isolating internet sex addiction as a potential driver highlights the need to address objectifying behaviours in individuals struggling with this addiction.

• Publikační typ
• časopisecké články MeSH

Background/Objectives: To evaluate the effectiveness of curative (chemo)radiotherapy in patients with hypopharyngeal carcinoma and to identify prognostic factors influencing treatment outcomes. Methods: We conducted a retrospective study of 173 consecutive patients, treated with definitive or postoperative (chemo)radiotherapy from 2002 to 2020 [median age 60 years; current/former smokers 95%; UICC stage III/IV 96%]. Radiation therapy was preceded by a radical resection of a primary tumor in 32% of patients. One hundred patients received chemotherapy. Results: The median total dose of radiotherapy achieved was 70 Gy. The five- and ten-year locoregional controls were 63%, and the five- and ten-year distant controls were 77% and 76%, respectively. The five- and ten-year overall survival rates were 24% and 9%, respectively. Conclusions: The results demonstrate the limited effectiveness of curative (chemo)radiotherapy in patients with hypopharyngeal carcinoma with long-term locoregional and distant control of half of the treated patients. The multivariate analysis indicated that initial surgery, chemotherapy, comorbidity score (as assessed by ACE-27), pretreatment tracheostomy, hemoglobin level and initial response to treatment were the strongest prognostic factors in predicting survival. Using these factors, corresponding predictive models were constructed.

• Publikační typ
• časopisecké články MeSH

The COVID-19 pandemic severely influenced human behavior due to governmental restrictions. In addition to administrative restrictions, other factors, like historical disease prevalence and culture might impact on recent behavior. The parasite stress theory of values and sociality predicts an influence of historical diseases on human culture and may be of important influence on current human behavioral responses towards the pandemic. To address the influence on behavior, we studied mask use in outdoor recreationists (N = 4863) from 53 cultures. Studying outdoor recreationists is advantageous because people have at least some choices over their mask use, and it is less strictly controlled. We hypothesize that pathogen prevalence and cultural values of a society predict mask usage above and beyond the simplistic explanation of the strength of the governmental pandemic-related restrictions. Our results indicate that societal variables, especially individualism, contribute to the mask use during leisure activities, with people from more individualistic societies reporting lesser mask usage. Further, historic pathogen prevalence has a significant influence on mask use, even when controlling for the stringency measures of the government, HDI and population density. Zoonotic disease richness, however, did not receive significance. A mediation model showed that historical pathogen prevalence had an indirect effect on mask use, via the two pathways collectivism-individualism and governmental regulations. The total effect size of pathogen prevalence on mask use was 0.61, and with 0.24 as direct, and 0.37 indirect effects. Our data fit into the parasite stress theory of values and sociality. Our results provide evidence that the governmental decisions and restrictions themselves are influenced by the historical pathogens.

• Publikační typ
• časopisecké články MeSH

Background/Objectives: Lumbar disk herniation (LDH) significantly affects quality of life due to lower back and radiating leg pain. Surgical intervention, such as discectomy, is effective for symptom relief when conservative measures fail; however, psychological factors like anxiety, depression, and maladaptive coping strategies may negatively impact surgical outcomes. This study aims to assess the role of preoperative psychological evaluations in predicting postoperative recovery and to identify key psychological and functional predictors of surgical success. Methods: A prospective study was conducted on 888 patients undergoing microdiscectomy for LDH at Mater Olbia Hospital between December 2020 and December 2023. Preoperative evaluations included the Visual Analog Scale, Symptom Checklist 90-R, Oswestry Disability Index, and Short Form 36. Logistic regression models and ROC curve analysis were used to identify significant predictors of outcomes and evaluate model accuracy. Results: Preoperative pain levels and emotional well-being emerged as the strongest determinants of postoperative improvement in the Oswestry Disability Index. The predictive model demonstrated high specificity (90.2%) in identifying patients likely to benefit from surgery. Clinically significant improvements were achieved by 69% of patients, highlighting the importance of psychological and functional assessments. Conclusions: Preoperative psychological assessment is critical in predicting outcomes of lumbar disk herniation surgery. Addressing psychological factors preoperatively enhances recovery, supports personalized treatment planning, and improves patient education. These findings advocate for an integrated care model that considers both physical and psychological health, optimizing surgical outcomes and patient satisfaction.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Spinal cord injury results in permanent neurological impairment and disability due to the absence of spontaneous regeneration. NG101, a recombinant human antibody, neutralises the neurite growth-inhibiting protein Nogo-A, promoting neural repair and motor recovery in animal models of spinal cord injury. We aimed to evaluate the efficacy of intrathecal NG101 on recovery in patients with acute cervical traumatic spinal cord injury. METHODS: This randomised, double-blind, placebo-controlled phase 2b clinical trial was done at 13 hospitals in the Czech Republic, Germany, Spain, and Switzerland. Patients aged 18-70 years with acute, complete or incomplete cervical spinal cord injury (neurological level of injury C1-C8) within 4-28 days of injury were eligible for inclusion. Participants were initially randomly assigned 1:1 to intrathecal treatment with 45 mg NG101 or placebo (phosphate-buffered saline); 18 months into the study, the ratio was adjusted to 3:1 to achieve a final distribution of 2:1 to improve enrolment and drug exposure. Randomisation was done using a centralised, computer-based randomisation system and was stratified according to nine distinct outcome categories with a validated upper extremity motor score (UEMS) prediction model based on clinical parameters at screening. Six intrathecal injections were administered every 5 days over 4 weeks, starting within 28 days of injury. Investigators, study personnel, and study participants were masked to treatment allocation. The primary outcome was change in UEMS at 6 months, analysed alongside safety in the full analysis set. The completed trial was registered at ClinicalTrials.gov, NCT03935321. FINDINGS: From May 20, 2019, to July 20, 2022, 463 patients with acute traumatic cervical spinal cord injury were screened, 334 were deemed ineligible and excluded, and 129 were randomly assigned to an intervention (80 patients in the NG101 group and 49 in the placebo group). The full analysis set comprised 78 patients from the NG101 group and 48 patients from the placebo group. 107 (85%) patients were male and 19 (15%) patients were female, with a median age of 51·5 years (IQR 30·0-60·0). Across all patients, the primary endpoint showed no significant difference between groups (with UEMS change at 6 months 1·37 [95% CI -1·44 to 4·18]; placebo group mean 19·20 [SD 11·78] at baseline and 30·91 [SD 15·49] at day 168; NG101 group mean 18·23 [SD 15·14] at baseline and 31·31 [19·54] at day 168). Treatment-related adverse events were similar between groups (nine in the NG101 group and six in the placebo group). 25 severe adverse events were reported: 18 in 11 (14%) patients in the NG101 group and seven in six (13%) patients in the placebo group. Although no treatment-related fatalities were reported in the NG101 group, one fatality not related to treatment occurred in the placebo group. Infections were the most common adverse event affecting 44 (92%) patients in the placebo group and 65 (83%) patients in the NG101 group. INTERPRETATION: NG101 did not improve UEMS in patients with acute spinal cord injury. Post-hoc subgroup analyses assessing UEMS and Spinal Cord Independence Measure of self-care in patients with motor-incomplete injury indicated potential beneficial effects that require investigation in future studies. FUNDING: EU program Horizon2020; Swiss State Secretariat for Education, Research and Innovation; Wings for Life; the Swiss Paraplegic Foundation; and the CeNeReg project of Wyss Zurich (University of Zurich and Eidgenössische Technische Hochschule Zurich).

• MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• krční mícha * zranění   MeSH
• krční obratle MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Nogo proteiny * MeSH
• poranění míchy * farmakoterapie   MeSH
• senioři MeSH
• spinální injekce * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Stratified and precision nutrition refers to disease management or prevention of disease onset, based on dietary interventions tailored to a person's characteristics, biology, gut microbiome, and environmental exposures. Such treatment models may lead to more effective management of inflammatory bowel disease (IBD) and reduce risk of disease development. This societal position paper aimed to report advances made in stratified and precision nutritional therapy in IBD. Following a structured literature search, limited to human studies, we identified four relevant themes: (a) nutritional epidemiology for risk prediction of IBD development, (b) food-based dietary interventions in IBD, (c) exclusive enteral nutrition (EEN) for Crohn's disease (CD) management, and (d) pre- and probiotics for IBD management. There is scarce literature upon which we can make recommendations for precision or stratified dietary therapy for IBD, both for risk of disease development and disease management. Certain single-nucleotide polymorphisms related to polyunsaturated fatty acid (PUFA) metabolism may modify the effect dietary PUFA have in increasing the risk of IBD development. Non-colonic CD, mild-to-moderate CD, and high microbiota richness may predict success of EEN and may be used both for prediction of treatment continuation, but also for early cessation in nonresponders. There is currently insufficient evidence to make recommendations for precision or stratified dietary therapy for patients with established IBD. Despite the great interest in stratified and precision nutrition, we currently lack data to support conclusive recommendations. Replication of early findings by independent research groups and within structured clinical interventions is required.

• MeSH
• Crohnova nemoc * terapie   MeSH
• dítě MeSH
• idiopatické střevní záněty * terapie   MeSH
• indukce remise MeSH
• lidé MeSH
• pomocný zdravotnický personál MeSH
• translační biomedicínský výzkum MeSH
• veřejné mínění MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH