Wilson disease (WD) primarily presents with hepatic and neurological symptoms. While hepatic symptoms typically precede the neurological manifestations, copper accumulates in the brain already in this patient group and leads to subclinical brain MRI abnormalities including T2 hyperintensities and atrophy. This study aimed to assess brain morphological changes in mild hepatic WD. WD patients without a history of neurologic symptoms and decompensated cirrhosis and control participants underwent brain MRI at 3T scanner including high-resolution T1-weighted images. A volumetric evaluation was conducted on the following brain regions: nucleus accumbens, caudate, pallidum, putamen, thalamus, amygdala, hippocampus, midbrain, pons, cerebellar gray matter, white matter (WM), and superior peduncle, using Freesurfer v7 software. Whole-brain analyses using voxel- and surface-based morphometry were performed using SPM12. Statistical comparisons utilized a general linear model adjusted for total intracranial volume, age, and sex. Twenty-six WD patients with mild hepatic form (30 ± 9 years [mean age ± SD]); 11 women; mean treatment duration 13 ± 12 (range 0-42) years and 28 healthy controls (33 ± 9 years; 15 women) were evaluated. Volumetric analysis revealed a significantly smaller pons volume and a trend for smaller midbrain and cerebellar WM in WD patients compared to controls. Whole-brain analysis revealed regions of reduced volume in the pons, cerebellar, and lobar WM in the WD group. No significant differences in gray matter density or cortical thickness were found. Myelin or WM in general seems vulnerable to low-level copper toxicity, with WM volume loss showing promise as a marker for assessing brain involvement in early WD stages.

• MeSH
• White Matter pathology   diagnostic imaging   MeSH
• Adult MeSH
• Hepatolenticular Degeneration * pathology   diagnostic imaging   MeSH
• Liver pathology   diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * MeSH
• Young Adult MeSH
• Brain * pathology   diagnostic imaging   MeSH
• Gray Matter pathology   diagnostic imaging   MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't 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.

• Publication type
• Journal Article MeSH

Syndrom vyhoření je v oblasti zdravotnictví významným problémem, který ovlivňuje nejen duševní, ale fyzickou pohodu zdravotníků, dokonce i kvalitu poskytované péče. Zvláště ohroženou skupinou profesionálů jsou všeobecné sestry pracující na jednotkách intenzivní péče, které jsou vystaveny denně vysokým pracovním nárokům, stresu a emočně náročným situacím. Jeden z faktorů, který prokazatelně přispívá k rozvoji syndromu vyhoření, je omezení profesní autonomie, tedy míra, do jaké mají všeobecné sestry možnost rozhodovat o své práci a vykonávat ji v rozsahu stanovených kompetencí dle vlastního úsudku. Cílem provedeného literárního review bylo analyzovat existující publikace vydané v letech 2020–2025 týkající se přímo všeobecných sester pracujících v intenzivní péči. Analýza již sama ukázala, že tato problematika je není doposud dostatečně prozkoumána a zaslouží si pozornost dalších výzkumníků. Porozumění těchto souvislostem může přispět k hledání strategií pro prevenci vyhoření a zlepšení pracovních podmínek a postavení všeobecných sester v intenzivní péči.

Jirkovská V, Dolák F. The impact of misunderstanding and limited professional autonomy of general nurses working in intensive care on the development of burnout syndrome Burnout is a significant problem in healthcare, affecting not only the mental but also the physical well-being of healthcare professionals and the quality of care provided. A particularly vulnerable group of professionals are general nurses working in intensive care units, who are exposed to high daily work demands, stress and emotionally demanding situations. One of the factors that has been shown to contribute to the development of burnout syndrome is the limitation of professional autonomy, i.e. the extent to which general nurses are able to make decisions about their work and exercise their own judgement within their defined competencies. The aim of the literature review was to analyse existing publications published between 2020 and 2025 that relate specifically to general nurses working in critical care. The analysis itself has already shown that this topic has not been sufficiently explored and deserves the attention of further researchers. Understanding these contexts can contribute to the search for strategies to prevent burnout and improve the working conditions and status of general nurses in critical care.

OBJECTIVE: To analyze the relationship among the professional role (student or professor), geographic location, and mental health in the university community after the COVID-19 pandemic. METHODS: . Quantitative cross-sectional study conducted at universities in Spain, Germany, and the Czech Republic. Non-probability convenience sampling was used, obtaining a sample of 449 participants (372 students and 77 professors). Mental health was assessed using the Scale for Mood Evaluation (EVEA), measuring sadness-depression, anxiety, anger-hostility, and happiness. RESULTS: Significant differences were found between students and professors, with students reporting higher levels of sadness-depression (3.8 vs. 2.4; p<0.001), anxiety (4.6 vs. 2.9; p<0.001), and anger-hostility (3.4 vs. 2.5; p<0.01). Professors showed higher levels of happiness (6.7 vs. 5.4; p<0.001). In addition, differences among countries were observed: participants from Spain showed higher levels of sadness-depression and anxiety compared to Germany and the Czech Republic. CONCLUSION: University students have greater emotional vulnerability than professors, highlighting the need for differentiated psy-chosocial support strategies in the academic setting.

• MeSH
• Faculty * psychology   statistics & numerical data   MeSH
• COVID-19 * psychology   epidemiology   MeSH
• Depression epidemiology   MeSH
• Adult MeSH
• Mental Health * MeSH
• Humans MeSH
• Young Adult MeSH
• Cross-Sectional Studies MeSH
• Cross-Cultural Comparison MeSH
• Happiness MeSH
• Students * psychology   statistics & numerical data   MeSH
• Universities MeSH
• Anxiety epidemiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH
• Germany MeSH
• Spain MeSH

Stálý zdravotně humanitární program České republiky MEDEVAC se zaměřuje na poskytování lékařské péče zranitelným skupinám obyvatelstva v regionech zasažených migrací, zatížených velkým množstvím uprchlíků nebo v místech, kde není dostupná specializovaná lékařská péče. Léčba je poskytována zdarma a výhradně civilistům, kteří se nacházejí ve vážném zdravotním stavu nebo kterým jejich zdravotní stav neumožňuje vést důstojný život. Program byl zahájen v roce 1993 v Bosně a Hercegovině, pokračoval v Kosovu a postupně byl rozšířen do řady dalších zemí. V současnosti je MEDEVAC programem Vlády ČR koordinovaným odborem azylové a migrační politiky Ministerstva vnitra ČR ve spolupráci s Ministerstvem zahraničních věcí ČR, Ministerstvem zdravotnictví ČR, Ministerstvem obrany ČR a Armádou ČR. Program MEDEVAC má zásadní vzdělávací význam. Účastníci si rozšiřují praktické zkušenosti se stavy typickými pro oblasti konfliktů a přírodních katastrof a seznamují se s organizačními zvláštnostmi péče v krizových oblastech. Zkušenosti získané v krizových oblastech jsou významným přínosem pro připravenost našeho zdravotnictví, zejména traumatologie a návazných oborů. Všeobecná fakultní nemocnice v Praze je zapojena od roku 2011 několika svými pracovišti – kromě I. chirurgické kliniky se na programu podílí i Oční klinika, Klinika rehabilitačního lékařství a Klinika gynekologie, porodnictví a neonatologie.

The MEDEVAC Permanent Medical Humanitarian Program of the Czech Republic focuses on providing medical care to vulnerable groups of the population in regions affected by migration, burdened by many refugees or in places where specialized medical care is not available. Treatment is provided free of charge and exclusively to civilians who are in a serious health condition or whose health condition does not allow them to lead a dignified life. The program started in 1993 in Bosnia and Herzegovina, continued in Kosovo and has gradually been extended to several other countries. At present, MEDEVAC is a program of the Government of the Czech Republic coordinated by the Department of Asylum and Migration Policy of the Ministry of the Interior of the Czech Republic in cooperation with the Ministry of Foreign Affairs, the Ministry of Health, the Ministry of Defense and the Army of the Czech Republic. The MEDEVAC program is of fundamental educational importance. Participants expand their practical experience with situations typical of conflict and natural disaster areas and become acquainted with the organizational specifics of care in crisis areas. The experience gained in crisis areas is a significant contribution to the preparedness of our health care system, especially traumatology and related fields. The General University Hospital in Prague has been involved in several of its departments since 2011, in addition to the First Surgical Clinic, the Department of Ophthalmology, the Department of Rehabilitation Medicine and the Department of Gynaecology, Obstetrics and Neonatology.

BACKGROUND: Drug consumption rooms (DCRs) are harm reduction facilities providing safer and hygienic setting for supervised administration of drugs aimed at decreasing negative health and social consequences of drug use. The first DCR in Czechia was opened in September 2023 in city of Brno in a mobile form operating in a socially excluded area (SEA). A research project informed the implementation of the DCR. METHODS: A mixed methods design was applied in the following phases: desk review, research before and after the launch of the mobile DCR, and routine monitoring of programme performance. Two cross-sectional questionnaire surveys among PWUDs (n = 131 and 135), ethnographic observation, focus group (n = 19), interviews with PWUDs (n = 26 and 19), with personnel of addiction services and local officials (n = 16 and 12), and residents (n = 7 and 6) were performed prior to and after the launch of the DCR. Thematic analysis of qualitative data, descriptive and regression analyses of quantitative data were performed. RESULTS: There was a need and high willingness to use the DCR among potential clients. The significant predictors were opioid use (adjusted odds ratio, AOR = 3.4 in survey 1 and 3.9 in survey 2), drug injection in the last 30 days (AOR 4.3 in survey 1), being in the probationary period during the previous 30 days (AOR 10.0 in survey 1), witnessing an overdose in the past 30 days (AOR 8.5 in survey 2), HCV positivity ever in life (AOR 2.9 in survey 2), living in SEA (AOR 2.7 in survey 2) and Roma ethnicity (AOR 2.8 in survey 2). The beginnings of the DCR were relatively slow with low initial number of clients and drug administrations. However, with time, and programme adjustments following research results, the attendance at the facility has grown. CONCLUSIONS: Research was instrumental in shaping the DCR in Brno before and during its implementation. The DCR showed a potential to attract the most vulnerable PWUDs from SEA. Despite a slow start, the DCR has become an integral part of low-threshold services for PWUDs in Brno and has proven its feasibility in the Czech settings.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Mobile Health Units * organization & administration   MeSH
• Substance-Related Disorders * MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Harm Reduction * MeSH
• Drug Users * statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

UNLABELLED: Despite significant advances in knowledge and the development of guidelines, the management of hypoplastic left heart syndrome (HLHS) remains highly variable. A structured questionnaire was circulated across European Association of Paediatric & Congenital Cardiology (AEPC) affiliated centres. The aims were to evaluate standards in pre-operative assessment, types of surgery, follow-up and medical practices in children with HLHS. Thirty-one centres from 20 countries completed the survey. Delivery of babies with HLHS occurred in co-located maternity hospitals in 74% of centres; 29% were planned for spontaneous onset of labour, while 54% decided on a case-by-case basis. The preferred initial palliation was a right ventricle-pulmonary artery conduit in 55% of cases, modified Blalock-Thomas Taussig shunt (mBTTS) in 35%, and hybrid in 15% of cases. Timing for Glenn varied from 3 to 6 months of age and preoperative examination varied greatly: 65% performed cardiac catheterization and only 19% performed cardiac magnetic resonance. Stage III palliation was performed at a highly variable interval (2-6 years of age), nearly always employing an extracardiac conduit. Fenestration was routinely performed in 61% and reserved for borderline cases in 39%. All the centers adopted warfarin for the first 3-12 months after Fontan completion, and continued if a fenestration was present, while in non-fenestrated aspirin was left by most centers (e.g. 68%). However, there was a high disparity in the use of heart failure medications (e.g. in interstage I-II 35% use ACE-inhibitors, and only 26% digoxin). Follow-up practice also varied widely with only 60% employing specific protocols. CONCLUSION: This first multi-centre European survey from 31 centres from 20 different European countries highlighted a high practice variation in HLHS management across all the stages of Single Ventricle (Fontan) palliation. Major variations pertained to pre- and post-surgical investigations, surgical strategy for stage I and III, medical treatment regimens, and follow-up programs. WHAT IS KNOWN: • Hypoplastic left heart syndrome (HLHS) remains one of the most complex and challenging congenital cardiac defects to manage. • Investigating the management of children with HLHS across different European centres can facilitate study of the most effective management strategies. WHAT IS NEW: • Significant variation in HLHS management were reported in relation to pre- and post-surgical examinations, surgical strategy at stage I and III, medical treatment regimens, and follow-up programs. • Greater standardisation of imaging and diagnostic evaluation, medical treatment and follow-up surveillance may improve outcomes for these vulnerable patients and warrants further study.

• MeSH
• Child MeSH
• Infant MeSH
• Practice Patterns, Physicians' * statistics & numerical data   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Palliative Care MeSH
• Child, Preschool MeSH
• Surveys and Questionnaires MeSH
• Hypoplastic Left Heart Syndrome * surgery   diagnosis   therapy   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

Genomic alterations and enormous monoclonal immunoglobulin production cause multiple myeloma to heavily depend on proteostasis mechanisms, including protein folding and degradation. These findings support the use of proteasome inhibitors for treating multiple myeloma and mantle cell lymphoma. Myeloma treatment has evolved, especially with the availability of new drugs, such as proteasome inhibitors, into therapeutic strategies for both frontline and relapsed/refractory disease settings. However, proteasome inhibitors are generally not effective enough to cure most patients. Natural resistance and eventual acquired resistance led to relapsed/refractory disease and poor prognosis. Advances in the understanding of cellular proteostasis and the development of innovative drugs that also target other proteostasis network components offer opportunities to exploit the intrinsic vulnerability of myeloma cells. This review outlines recent findings on the molecular mechanisms regulating cellular proteostasis pathways, as well as resistance, sensitivity, and escape strategies developed against proteasome inhibitors and provides a rationale and examples for novel combinations of proteasome inhibitors with FDA-approved drugs and investigational drugs targeting the NRF1 (NFE2L1)-mediated proteasome bounce-back response, redox homeostasis, heat shock response, unfolding protein response, autophagy, and VCP/p97 to increase proteotoxic stress, which can improve the efficacy of antimyeloma therapy based on proteasome inhibitors.

• MeSH
• Drug Resistance, Neoplasm MeSH
• Proteostasis * drug effects   MeSH
• Proteasome Inhibitors * therapeutic use   pharmacology   MeSH
• Humans MeSH
• Multiple Myeloma * drug therapy   metabolism   MeSH
• Antineoplastic Agents * therapeutic use   pharmacology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Exposure to benzophenone-1 (BP-1) and benzophenone-3 (BP-3), widely used as UV filters in personal care products, has been associated with adverse health effects. However, epidemiological evidence is limited and inconclusive, particularly in vulnerable populations such as teenagers. OBJECTIVE: To examine the relation between BP-1 and BP-3 concentrations and obesity, cardiometabolic biomarkers, and asthma/allergy outcomes in European teenagers, including possible sex-specific associations. METHODS: A multi-country cross-sectional study was conducted using pooled data from six aligned studies from the Human Biomonitoring for Europe Initiative (HBM4EU). Sociodemographic data, cardiometabolic biomarkers, and asthma/allergy outcomes were collected through questionnaires. Anthropometric data and BMI z-scores were calculated (n = 1339). Plasma/serum cardiometabolic biomarkers and asthma/allergy outcomes were available for a subsample (n = 173-594). Urinary BP-1 and BP-3 concentrations were adjusted for creatinine dilution using the traditional standardization (trad.) and the covariate-adjusted creatinine standardization (CAS) method. Generalized additive models, linear, logistic, and multinomial mixed models were applied, and sex-interaction terms were tested. RESULTS: Each natural log-unit increase in urinary BP-3 (CAS) concentrations was associated with higher odds of obesity in the whole population (OR: 1.20; 95%CI: 1.04-1.38). Sex-specific associations were also found with BP-1 (CAS) and BP-3 (CAS) concentrations, which were associated with higher odds of obesity in male teenagers (OR: 1.25; 95% CI: 1.01-1.55; OR: 1.34; 95%CI: 1.09-1.65, respectively). Linear mixed models showed consistent findings toward higher BMI z-scores. A negative association was found between BP-1 (CAS) concentration and serum adiponectin levels in females (% change per loge-unit increase: -3.73, 95%CI: -7.32, -0.10). BP-3 (CAS) concentrations were also associated with higher odds of non-food allergies in males (OR: 1.27; 95%CI: 1.00-1.63). Traditional creatinine adjustment showed similar or slightly attenuated estimates compared to the CAS method. CONCLUSIONS: BP-1 and BP-3 exposure was cross-sectionally associated with higher odds of obesity in European male teenagers, highlighting the need to update regulations and keep exposure levels as low as practically achievable. Longitudinal studies are needed to confirm these findings.

• MeSH
• Hypersensitivity * epidemiology   MeSH
• Benzophenones * toxicity   urine   adverse effects   MeSH
• Biomarkers blood   MeSH
• Biological Monitoring MeSH
• Asthma * epidemiology   chemically induced   MeSH
• Humans MeSH
• Adolescent MeSH
• Obesity * epidemiology   chemically induced   MeSH
• Sunscreening Agents * adverse effects   MeSH
• Cross-Sectional Studies MeSH
• Environmental Exposure * MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

OBJECTIVES: The aim of this study was to examine the frequency of fatalities in injuries in traffic accidents in Montenegro, identify contributing risk factors, and determine the most vulnerable participants in these accidents. METHODS: The research was designed as a retrospective descriptive study. Participants were people admitted to the Urgent Centre of Clinical Centre of Montenegro due to injuries in traffic accidents that resulted in serious bodily injury or death in the period from 2011-2020. We presented data using descriptive statistics. The square test was used to examine the association between the outcome of traffic injury with sex, age, category of injury, type of traffic participant, and injury localisation. Additionally, we used logistic regression to estimate the best predictor value of these variables for outcome. RESULTS: It was found that 44.7% of injured people died, the most frequent fatal outcome was registered in patients with central nervous system injuries (73.2%), then in patients with asphyxia (47.0%), and patients with bleeding (40.5%), χ2 = 27.530, p < 0.001. The most frequently injured traffic participants were drivers, but the highest number of deceased were among cyclists. Also, logistic regression showed that the category of injury was the most predictive impact on outcome in traffic-injured correspondents (p < 0.001). CONCLUSION: Among the injured, the highest number are drivers, and the fatal outcome mostly depends on the injury category. Nearly half of those injured in traffic accidents die, especially those with central nervous system injuries and cyclists. Therefore, special attention should be given during public health campaigns related to traffic accident prevention, focusing on this injury and this category of traffic participants.

• MeSH
• Child MeSH
• Accidents, Traffic * statistics & numerical data   mortality   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Wounds and Injuries * mortality   epidemiology   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Montenegro MeSH