Cíl: V retrospektivní studii jsme porovnali efektivitu navigace punkce portální žíly pomocí abdominální ultrasonografie oproti CO2 portografii. Efektivitu navigace jsme posuzovali dle počtu punkcí nutných k dosažení katetrizace větve vena portae, délkou skiaskopie a radiační dávkou charakterizovanou produktem dávkové plochy (DAP). Metodika: Do studie bylo zahrnuto 102 po sobě jdoucích pacientů, kterým byl proveden TIPS v období 3 let (od počátku roku 2022 do konce roku 2024). V souboru bylo 29 žen (28 %) a 73 mužů (72 %), ve věkovém rozmezí 27–81 let. Hlavní indikací k TIPS byl refrakterní ascites u 52 (51 %) a krvácení při portální hypertenzi u 50 pacientů (49 %). TIPS byl proveden jako urgentní výkon u 19 pacientů (v 18,6 %) pro nezastavené variceální krvácení. Childovo-Pughovo skóre A bylo 22 % pacientů, Childovo-Pughovo skóre B 44 % a Childovo-Pughovo skóre C 26 %, u 8 % pacientů nebyla klasifikace zjistitelná. Výsledky: Ze 102 TIPS výkonů nebyl tento zaveden u tří pacientů pro technické selhání (2,9 %). Počet vpichů nutných k dosažení portální žíly se zavedením vodiče byl v průměru 5,6 (od jednoho do 20) u 50 pacientů, jejichž punkce byla naváděna pomocí CO2 portografie. U 28 výkonů, kde byl k navádění použit UZ, bylo průměrně nutných 2,7 vpichů (od jednoho do šesti). Délka skiaskopie byla u 28 výkonů provedených pomocí navigace CO2 v průměru 28 minut (9–50 min), u 28 výkonů s navigací pod UZ to bylo 22,8 min (8–43 min). Ve skupině 19 výkonů před obměnou angiolinky a s CO2 navigací byl v průměru DAP 181 497 mGy/cm2 (27 649–399 657 mGy/cm2 ), ve skupině 17 výkonů po obměně angiolinky a navigovaných pomocí CO2 portografie byl DAP v průměru 159 339 mGy/cm2 (52 613–309 440 mGy/cm2 ) a v časově nejmladší skupině 21 výkonů navigovaných pomocí UZ byl DAP v průměru 120 731 mGy/cm 2 (38 180–315 121 mGy/cm2 ). U sedmi výkonů bylo provedeno měření dávky osobními dozimetry. V části výkonu do zavedení vodiče do portální žíly operatér měl dávku v průměru 6 μSv (0 do 12 μSv), zatímco lékař provádějící UZ navigaci v průměru 4,4 μSv (0 do 9 μSv). Celková dávka pro operatéra byla v průměru 19,5 μSv (8–35 μSv). Závěr: Z naměřených hodnot lze uzavřít, že počet vpichů při navigaci pomocí UZ klesl v průměru z 5,6 na 2,7, tento rozdíl se velmi blíží statistické významnosti (p = 0,052). Skiaskopický čas při výkonu klesl v průměru o 7 minut. Dávka druhého lékaře navigujícího punkci pomocí UZ je do doby katetrizace por- tální žíly srovnatelná s dávkou operatéra. DAP klesl po inovaci přístroje a na novém přístroji a dále ještě více klesl i u výkonů prováděných s navigací punkce pomocí UZ.

Aim: In our retrospective study, we compared the efficacy of portal vein puncture navigation using abdominal ultrasonography versus CO2 portography. We assessed navigation efficiency according to the number of punctures required to achieve vena portae branch catheterization, the length of the fluoroscopy, and the dose area product (DAP). Method: The study included 102 consecutive patients who underwent TIPS over a 3-year period (from the beginning of 2022 to the end of 2024). In this cohort, there were 29 women (28%) and 73 men (72%), ranging in age from 27 to 81 years. The main indications for TIPS were refractory ascites in 52 patients (51%) and bleeding with portal hypertension in 50 patients (49%). TIPS was performed as an emergency procedure in 19 patients (18.6%) for uncontrolled variceal bleeding. Child Pugh A, Child Pugh B and Child Pugh C were 22%, 44% and 26% respectively, with 8% of patients having no detectable classification. Results: Of the 102 TIPS procedures, TIPS was not inserted in 3 patients due to technical failure (2.9%). The number of punctures required to reach the portal vein with guidewire insertion averaged 5.6 (range 1 to 20) in 50 patients whose puncture was guided by CO2 portography. In the 28 procedures where ultrasound was used for guidance, the mean number of punctures required was 2.7 (range, 1 to 6). The mean duration of fluoroscopy was 28 min (9–50 min) in the 28 procedures performed with CO2 guidance and 22.8 min (8–43 min) in the 28 procedures with ultrasound guidance. In the group of 19 procedures before angiomachine exchange and with CO2 navigation, the mean DAP was 181 497 mGy/ cm2 (27 649–399 657 mGy/cm2 ), in the group of 17 procedures after angiomachine exchange and navigated by CO 2 portography, the DAP averaged 159 339 mGy/cm 2 (52 613–309 440 mGy/cm2 ) and in the youngest group of 21 procedures navigated by ultrasound, the DAP averaged 120 731 mGy/cm2 (38 180–315 121 mGy/cm 2 ). Dose measurements with personal dosimeters were performed for 7 procedures. In the part of the procedure until the insertion of the guidewire into the portal vein, the operator had a dose of 6 μSv (0 to 12 μSv) on average, while the physician performing the ultrasound navigation had a dose of 4.4 μSv (0 to 9 μSv) on average. The total dose to the operator averaged 19.5 μSv (8 to 35 μSv). Conclusion: From the measured values it can be concluded that the number of punctures during navigation with US decreased from 5.6 to 2.7 on average, this result is close to statistic significance (p = 0.052). The fluoroscopic time during the procedure decreased by 7 minutes. However, the dose of the second physician navigating the puncture using ultrasound is comparable to that of the main operator. The DAP decreased after the device upgrade, and even more decreased for procedures performed with ultrasound-guided puncture navigation.

U pacientů s časným karcinomem hrtanu je v současnosti chirurgická léčba zachovávající funkci hrtanu preferovanou primární léčebnou modalitou. Cílem je odstranění karcinomu hrtanu s negativními okraji se současným zachováním přiměřené kvality hlasu a dýchání bez nutnosti tracheostomie. Mezi chirurgické postupy šetřící hrtan patří transorální endoskopická chirurgie, robotická mikrochirurgie hrtanu a vertikální parciální laryngektomie ze zevního přístupu (VPL). Cíl: Cílem studie bylo analyzovat faktory, které jsou zohledňovány při současných indikacích parciálních laryngektomií prováděných ze zevního přístupu pro glotický karcinom a zhodnotit chirurgické a onkologické výsledky těchto operací. Materiál a metodika: Do retrospektivní studie bylo zařazeno 18 pacientů, u nichž byla od 1. 1. 2012 do 31. 12. 2022 na Klinice otorinolaryngologie a chirurgie hlavy a krku FN u sv. Anny v Brně provedena VPL pro glotický spinocelulární karcinom. U 12 (67 %) pacientů byla předléčebná klasifikace nádoru cT1, u 6 (33 %) pacientů cT2. Nejčastěji prováděným výkonem byla laryngofi sura s rozšířenou chordektomií, která byla indikována u 17 (94 %) pacientů; frontální parciální laryngektomie byla provedena u jednoho pacienta (6 %). Nejčastější indikací k VPL byla konverze původně zvoleného endoskopického přístupu u 10 (56 %) pacientů, u 3 (17 %) pacientů se jednalo o revizní výkon po neradikálním endoskopické operaci a v 5 (28 %) případech byla VPL indikována z jiných důvodů. Výsledky: Mezi nejvýznamnější klinické rizikové faktory zohledněné při indikaci VPL patřily: omezená expozice nitra hrtanu v 11 případech, infiltrace přední komisury v 10 případech, šíření nádoru do paraglotického prostoru v 5 případech, subglotická propagace ve 4 případech, postižení processus vocalis ve 3 případech a nádorové šíření do laryngeálního ventrikulu ve 3 případech. Hodnocení resekčních okrajů prokázalo negativní resekční okraje (R0) u 8 (44 %) pacientů, blízké okraje (R0) u 6 (33 %) pacientů a pozitivní resekční okraje (R1) u 4 (22 %) pacientů. Pooperační průběh byl u většiny pacientů příznivý, přičemž u 15 (71 %) pacientů nenastaly žádné komplikace. Mírné lokální komplikace se vyskytly u 5 (24 %) pacientů, zatímco závažné komplikace nebyly zaznamenány u žádného z nich. Medián doby sledování činil 3,0 roku s interkvartilovým rozptylem 2,0 až 5,0 let. U jednoho pacienta byla dia- gnostikována recidiva karcinomu po VPL a adjuvantní radioterapii. U tohoto pacienta byla finálně indikována záchranná totální laryngektomie. Pravděpodobnost přežití byla stanovena Kaplan-Meierovou analýzou: 1 rok 90,5 %; 2 roky 85,7 %; 3 roky 85,7 %; 4 roky 77,1 %; 5 let 66,1 %. Závěr: Ačkoli jsou indikace pro zevní přístupy v současnosti velmi omezené, VPL stále představují záložní chirurgickou variantu u pacientů s omezenou expozicí vnitra hrtanu a u glotických nádorů postihujících rizikové anatomické sublokality, především přední komisuru a paraglotický prostor. I s ohledem na naše výsledky lze laryngofisuru s rozšířenou chordektomií považovat za hrtan šetřicí postup, který nabízí funkčně přijatelné a onkologicky srovnatelné výsledky léčby časného glotického karcinomu v porovnání s preferovanými endoskopickými přístupy a radioterapií.

For patients with early-stage laryngeal carcinoma, function-preserving surgical treatment is currently the preferred primary therapeutic modality. The goal is to achieve complete tumor removal with negative margins while preserving adequate voice quality and respiration without the need for a tracheostomy. Larynx-preserving surgical approaches include transoral endoscopic surgery, robotic microlaryngeal surgery, and external vertical partial laryngectomy (VPL). Objective: The aim of this study was to analyze the factors influencing current indications for open partial laryngectomies for glottic carcinoma and to evaluate the surgical and oncological outcomes of these procedures. Materials and methods: 18 patients who underwent VPL for glottic squamous cell carcinoma from 1. 1. 2012 to 31. 12. 2022 at the Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne‘s Hospital in Brno were included in the retrospective study. Pre-treatment tumor classification was cT1 in 12 (67%) patients and cT2 in 6 (33%) patients. The most commonly performed procedure was laryngofissure with extended chordectomy in 17 (94%) patients; frontal partial laryngectomy was performed in one patient (6%). The most frequent indication for VPL was conversion of the initially chosen endoscopic approach in 10 (56%) patients, revision surgery following a non-radical endoscopic procedure in 3 (17%) patients, and other indications in 5 (28%) cases. Results: The most significant clinical risk factors considered in the indication for VPL included: limited exposure of the larynx in 11 cases, anterior commissure infiltration in 10 cases, tumor spread to the paraglottic space in 5 cases, subglottic extension in 4 cases, involvement of the vocal process in 3 cases, and tumor spread to the laryngeal ventricle in 3 cases. Evaluation of resection margins showed negative resection margins (R0) in 8 (44%) patients, close margins (R0) in 6 (33%) patients, and positive resection margins (R1) in 4 (22%) patients. Postoperative course was favorable in most patients, with no complications in 15 (71%) patients. Mild local complications occurred in 5 (24%) patients, while no severe complications were noted in any of them. The median follow-up period was 3.0 years, with an interquartile range of 2.0 to 5.0 years. Recurrence of carcinoma after VPL and adjuvant radiotherapy was diagnosed in one patient, who ultimately underwent salvage total laryngectomy. Survival probability was estimated using the Kaplan-Meier analysis: 1-year survival at 90.5%, 2-year survival at 85.7%, 3-year survival at 85.7%, 4-year survival at 77.1%, and 5-year survival at 66.1%. Conclusion: Although indications for external approaches are currently very limited, VPL still represents a salvage surgical option for patients with limited laryngeal exposure and for glottic tumors affecting high-risk anatomical subsites, particularly the anterior commissure and paraglottic space. Even considering our results, laryngofissure with extended cordectomy can be regarded as a larynx-preserving procedure that offers functionally acceptable and oncologically comparable treatment outcomes for early glottic carcinoma in comparison with preferred endoscopic approaches and radiotherapy.

• MeSH
• Laryngectomy * classification   methods   statistics & numerical data   MeSH
• Larynx surgery   pathology   MeSH
• Humans MeSH
• Laryngeal Neoplasms surgery   diagnosis   MeSH
• Otorhinolaryngologic Surgical Procedures methods   MeSH
• Retrospective Studies MeSH
• Carcinoma, Squamous Cell surgery   diagnosis   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

INTRODUCTION: Retroperitoneal lymph node dissection (RPLND) is crucial in managing metastatic germ cell tumors (GCTs), particularly post-chemotherapy. Given the long-term survival of these patients, perioperative morbidity is a significant concern. However, data on RPLND morbidity using predefined reporting standards are scarce. This study aims to address this gap by utilizing updated European Association of Urology (EAU) guidelines for standardized complication reporting. PATIENTS AND METHODS: A retrospective analysis was conducted on patients who underwent RPLND for GCTs between 2010 and 2022. 30-day complications were extracted from digital charts using a predefined procedure-specific catalog. Complications were graded using the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI) was calculated for each patient. RESULTS: Sixty-nine men underwent RPLND at a median age of 32 years (IQR 25-38). Chemotherapy was administered to 64 patients (93 %), with 48 (70 %) having negative tumor markers. Median tumor diameter was 52 mm (IQR 35-83), and median operative time was 197 min (IQR 128-262). Unilateral template removal was performed in 55 patients (80 %). A total of 157 complications were reported in 66 patients (96 %), with anemia (33 %) and gastrointestinal issues (24 %) being the most common. Five patients (7.2 %) had "major" complications (CDC grade ≥ IIIa), and the median CCI was 12 (IQR 9-23). Using the CCI, the proportion of patients with a "major" complication burden increased to 14 %, compared to 8.5 % by CDC alone. The primary limitation of this study is its retrospective design and the limited 30-day follow-up period. CONCLUSION: Most patients experience postoperative complications after RPLND, though severe complications are rare. These findings could improve patient counseling when discussing testicular cancer therapy options.

• MeSH
• Adult MeSH
• Neoplasms, Germ Cell and Embryonal * surgery   pathology   MeSH
• Humans MeSH
• Lymph Node Excision * adverse effects   MeSH
• Morbidity MeSH
• Follow-Up Studies MeSH
• Postoperative Complications * epidemiology   etiology   MeSH
• Prognosis MeSH
• Retroperitoneal Space surgery   pathology   MeSH
• Retrospective Studies MeSH
• Practice Guidelines as Topic * standards   MeSH
• Testicular Neoplasms * surgery   pathology   MeSH
• Urology standards   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Scoping Review MeSH

BACKGROUND AND OBJECTIVE: There are limited data on real-world outcomes for patients with advanced or metastatic urothelial cancer (mUC) since immune checkpoint inhibitors (ICIs) became available. Our objective was to analyze outcomes for patients with mUC since ICIs became available. METHODS: We performed a retrospective analysis of 131 patients with mUC attending the outpatient clinic of a single tertiary care center who received systemic therapy between June 2017 and July 2021 with follow-up up to December 2022. Summary and descriptive statistics were calculated for categorical and continuous variables. The Kaplan-Meier method was applied to calculate survival, and a Cox proportional-hazards model was used to explore associations between clinical variables and outcomes. KEY FINDINGS AND LIMITATIONS: The median patient age was 68 yr (range 35-90). The first systemic therapy administered was platinum-based in 79% of cases and ICI-based in 21%. Some 61% of the cohort received a second systemic treatment, with 75% of these an ICI. Median overall survival for the entire cohort was 24 mo (interquartile range 9-35). Patients on ICI therapy for ≥6 mo had median overall survival of 59 mo (95% confidence interval 39 mo-not reached). Metastatic sites on initiation of ICI therapy and C-reactive protein kinetics were prognostic in patients receiving ICIs. Limitations include the retrospective design and inherent selection bias. CONCLUSIONS AND CLINICAL IMPLICATIONS: More than 60% of patients with mUC received second-line treatment, and 75% of these received an ICI. Patients staying on immunotherapy for more than 6 mo have substantially better outcomes in comparison to patients with less time on immunotherapy and historical cohorts. PATIENT SUMMARY: We looked at the lines of therapy and outcomes for patients with advanced or metastatic cancer of the urinary tract, starting from when immunotherapy drugs called immune checkpoint inhibitors (ICIs) became available. We found that 60% of patients have received second-line therapy, which is a double the rate in comparison to historical groups of patients. Patients with long-term ICI therapy (>6 months) had significantly better outcomes, with a median survival of more than 3 years.

• MeSH
• Adult MeSH
• Immunotherapy * methods   MeSH
• Immune Checkpoint Inhibitors * therapeutic use   MeSH
• Carcinoma, Transitional Cell * drug therapy   secondary   pathology   MeSH
• Practice Patterns, Physicians' statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Metastasis MeSH
• Survival Rate MeSH
• Urinary Bladder Neoplasms * drug therapy   pathology   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Neoplasm Staging MeSH
• Urologic Neoplasms drug therapy   pathology   MeSH
• Treatment Outcome 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

Kontext: Poškození myokardu po nekardiálním chirurgickém výkonu (myocardial injury after non-cardiac surgery, MINS) představuje závažný problém přímo související s mortalitou do 30 dnů po výkonu. V diagnostice poškození myokardu se přednostně používají hodnoty vysoce senzitivního srdečního troponinu (high-sensitivity cardiac troponin, hs troponin), protože se v současnosti jedná o nejcitlivější a nejspecifičtější srdeční biomarker vhodný pro zjišťování MINS. Cílem této studie je analyzovat vztah mezi změnami v hodnotách hs troponinu a riziky spojenými s chirurgickým výkonem u pacientů podstupujících nekardiální chirurgické výkony, které by ukazovaly na poškození myokardu. Metoda: Naše studie je analytickou observační průřezovou studií, do níž byli zařazováni všichni pacienti pod-tupující nekardiální chirurgický výkon ve fakultní nemocnici Airlangga University Hospital. Krevní vzorky byly odebírány metodou náhodného vzorku (consecutive sampling) a hodnoty hs troponinu se stanovovaly před operací a 24 hodin po ní. Míra operačního rizika se hodnotila pomocí kritérií doporučených postupů ESAIC-ESC 2022. Statistická analýza se prováděla s použitím Spearmanova korelačního koeficientu. Výsledky: Do studie bylo zařazeno 75 pacientů, 39 mužů a 36 žen, ve věku s mediánem 54 let. Výsledky prokázaly statisticky významnou korelaci mezi hodnotami hs troponinu a mírou operačního rizika, a to jak předoperačními hodnotami, tak i pooperačními a jejich změnami. Medián hodnoty (mezikvartilové rozpětí) hs troponinu při nízkém operačním riziku před operací vs. po operaci činil 1,2 ng/l (0,0), resp. 1,2 ng/l (0,0), s mediánem rozdílu 0,0 ng/l (0,0); p < 0,001. Medián hodnoty hs troponinu při středně vysokém operačním riziku před operací vs. po operaci byl 1,2 ng/l (0,0) vs. 1,2 ng/l (0,0), s mediánem rozdílu 0,0 ng/l (1,6); p < 0,001. Medián hodnoty hs troponinu při vysokém operačním riziku před operací vs. po operaci byl 1,7 ng/l (18,8) vs. 11,9 ng/l (27,6); medián rozdílu činil 5,3 ng/l (11,4); p < 0,001. Závěr: Byla nalezena statisticky významná korelace mezi změnami hodnot hs troponinu a mírou operačního rizika a přítomností komplikací.

Background: Myocardial injury after non-cardiac surgery (MINS) is an important issue, directly related to the mortality rate within 30 days after surgery. High sensitivity cardiac troponin (HS troponin) is the preferred biomarker for diagnosing myocardial damage because it is the most sensitive and specific heart biomarker currently available, making it suitable for detecting MINS. The aim of this study is to analyse the relationship between changes in HS troponin levels and surgery-related risks in non-cardiac surgery patients as a marker of myocardial injury. Method: This study is an analytical observational cross sectional study that included all patients who underwent non-cardiac surgery in the Airlangga University Hospital. Samples were taken using the consecutive sampling method. HS troponin values were measured before surgery and 24 hours after surgery. The level of surgical risk was assessed based on the criteria from ESAIC-ESC 2022. Statistical analysis used Spear- man's correlation.

• MeSH
• Anesthesia adverse effects   MeSH
• Biomarkers blood   MeSH
• Surgical Procedures, Operative * adverse effects   MeSH
• Adult MeSH
• Cardiomyopathies diagnosis   etiology   blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cross-Sectional Studies MeSH
• Risk MeSH
• Aged MeSH
• Statistics as Topic MeSH
• Troponin * blood   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Observational Study MeSH

Cíl: Článek představuje výsledky výzkumu vlivu pracovní rehabilitace (PR) na kvalitu života osob se zdravotním postižením. Ve třech krajích České republiky byla v rámci projektu ESF (reg. č. CZ.03.3.X/0.0/0.0/17_082/0015504) zřízena tři experimentální pracovně rehabilitačních střediska, která ve spolupráci s Úřady práce ověřovala účinnost inovativním způsobem zabezpečené PR. Soubor a metodika: Do intervenční skupiny bylo zapojeno celkem 123 osob s různou mírou a typem zdravotního postižení. Kvalita života byla zkoumána u intervenční skupiny, tzn. účastníků PR zabezpečené ve spolupráci s pilotními pracovně rehabilitačními středisky, kteří souhlasili se zapojením do výzkumu (n = 93). Interventi byli dotazováni s využitím dotazníku WHODAS 2.0. U účastníků byly porovnány výsledky testování před vstupem do PR (A), při ukončení PR (B) a u zaměstnaných účastníků (n = 59) také 3 měsíce po nástupu do zaměstnání (C). Sběr dat proběhl v letech 2021–2022. Výsledky: Interventi, kteří si udrželi zaměstnání alespoň 3 měsíce, uváděli zvýšení kvality života ve všech šesti sledovaných oblastech. Signifikantní zvýšení kvality života bylo prokázáno zejména v doméně participace a životní aktivity. K měřitelnému zlepšení kvality života nedošlo pouze v doménách mobility a sebeobsluhy. Potíže s pohyblivostí a sebeobsluhou byly při vstupu do projektu celkově interventy vnímány jako nejméně problémové. Závěry: Výsledky výzkumu ukazují, že PR má vliv na zvýšení kvality života u zapojených účastníků. Ke zlepšení kvality života došlo u všech dotazovaných interventů v oblasti životní aktivity (zahrnující oblast práce) a účasti ve společnosti, a to bez ohledu na to, zda si udrželi nebo neudrželi zaměstnání alespoň 3 měsíce.

Objective: The article presents the results of research on the impact of vocational rehabilitation on the quality of life of persons with disabilities. In three regions of the Czech Republic, as part of an ESF project (reg. no. CZ.03.3.X/0.0/0.0/17_082/0015504), three experimental vocational rehabilitation centers were established. These centers, in collaboration with the Labor Offices, tested the effectiveness of innovative vocational rehabilitation methods. Sample and methodology: A total of 123 individuals with various degrees and types of disabilities were included in the intervention group (IG). The quality of life was examined in the IG, i.e., participants in the vocational rehabilitation program provided in cooperation with the pilot vocational rehabilitation centers, who agreed to participate in the research (N = 93). The participants were surveyed using the WHODAS 2.0 questionnaire. The results were compared before entering the vocational rehabilitation (A), at the end of the vocational rehabilitation (B), and for employed participants (N = 59), and also 3 months after starting employment (C). Data collection took place from 2021 to 2022. Results: Participants who maintained employment for at least three months reported an increase in quality of life in all six monitored areas. A significant increase in quality of life was particularly evident in the domains of participation and life activities. Measurable improvement in quality of life did not occur in the domains of mobility and self-care. Issues with mobility and self-care were generally perceived by participants as the least problematic at the project‘s outset. Conclusions: The research results indicate that vocational rehabilitation has a positive impact on improving the quality of life for participants involved. All surveyed participants experienced improvements in life activities (including work-related aspects) and social participation, regardless of whether they maintained employment for at least 3 months or not.

• MeSH
• Quality of Life * MeSH
• Humans MeSH
• Return to Work statistics & numerical data   MeSH
• Surveys and Questionnaires MeSH
• Rehabilitation, Vocational * statistics & numerical data   MeSH
• Rehabilitation organization & administration   statistics & numerical data   MeSH
• Statistics as Topic MeSH
• Social Participation MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. OBJECTIVE: We aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. DESIGN, SETTING, AND PARTICIPANTS: We identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. RESULTS AND LIMITATIONS: Overall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). CONCLUSIONS: One out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2-3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. PATIENT SUMMARY: Our novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.

• MeSH
• Humans MeSH
• Lymphadenopathy * pathology   surgery   MeSH
• Lymphatic Metastasis pathology   MeSH
• Lymph Nodes diagnostic imaging   surgery   pathology   MeSH
• Magnetic Resonance Imaging MeSH
• Prostatic Neoplasms * diagnostic imaging   surgery   pathology   MeSH
• Positron Emission Tomography Computed Tomography methods   MeSH
• Positron-Emission Tomography MeSH
• Prostate diagnostic imaging   surgery   pathology   MeSH
• Prostatectomy MeSH
• Prostate-Specific Antigen MeSH
• Seminal Vesicles pathology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT: The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION: In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Nephrectomy * methods   MeSH
• Tissue and Organ Harvesting methods   MeSH
• Robotic Surgical Procedures * methods   MeSH
• Kidney Transplantation * methods   MeSH
• Living Donors * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: Evidence suggests reduced survival rates following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in people with preexisting mental disorders, especially psychotic disorders, before the broad introduction of vaccines. It remains unknown whether this elevated mortality risk persisted at later phases of the pandemic and when accounting for the confounding effect of vaccination uptake and clinically recorded physical comorbidities. METHODS AND FINDINGS: We used data from Czech national health registers to identify first-ever serologically confirmed SARS-CoV-2 infections in 5 epochs related to different phases of the pandemic: 1st March 2020 to 30th September 2020, 1st October 2020 to 26th December 2020, 27th December 2020 to 31st March 2021, 1st April 2021 to 31st October 2021, and 1st November 2021 to 29th February 2022. In these people, we ascertained cases of mental disorders using 2 approaches: (1) per the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes for substance use, psychotic, affective, and anxiety disorders; and (2) per ICD-10 diagnostic codes for the above mental disorders coupled with a prescription for anxiolytics/hypnotics/sedatives, antidepressants, antipsychotics, or stimulants per the Anatomical Therapeutic Chemical (ATC) classification codes. We matched individuals with preexisting mental disorders with counterparts who had no recorded mental disorders on age, sex, month and year of infection, vaccination status, and the Charlson Comorbidity Index (CCI). We assessed deaths with Coronavirus Disease 2019 (COVID-19) and from all-causes in the time period of 28 and 60 days following the infection using stratified Cox proportional hazards models, adjusting for matching variables and additional confounders. The number of individuals in matched-cohorts ranged from 1,328 in epoch 1 to 854,079 in epoch 5. The proportion of females ranged from 34.98% in people diagnosed with substance use disorders in epoch 3 to 71.16% in individuals diagnosed and treated with anxiety disorders in epoch 5. The mean age ranged from 40.97 years (standard deviation [SD] = 15.69 years) in individuals diagnosed with substance use disorders in epoch 5 to 56.04 years (SD = 18.37 years) in people diagnosed with psychotic disorders in epoch 2. People diagnosed with or diagnosed and treated for psychotic disorders had a consistently elevated risk of dying with COVID-19 in epochs 2, 3, 4, and 5, with adjusted hazard ratios (aHRs) ranging from 1.46 [95% confidence intervals (CIs), 1.18, 1.79] to 1.93 [95% CIs, 1.12, 3.32]. This patient group demonstrated also a consistently elevated risk of all-cause mortality in epochs 2, 3, 4, and 5 (aHR from 1.43 [95% CIs, 1.23, 1.66] to 1.99 [95% CIs, 1.25, 3.16]). The models could not be reliably fit for psychotic disorders in epoch 1. People diagnosed with substance use disorders had an increased risk of all-cause mortality 28 days postinfection in epoch 3, 4, and 5 (aHR from 1.30 [95% CIs, 1.14, 1.47] to 1.59 [95% CIs, 1.19, 2.12]) and 60 days postinfection in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.08, 1.38] to 1.52 [95% CIs, 1.16, 1.98]). Cases ascertained based on diagnosis of substance use disorders and treatment had increased risk of all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.03, 1.43] to 1.91 [95% CIs, 1.25, 2.91]). The models could not be reliably fit for substance use disorders in epoch 1. In contrast to these, people diagnosed with anxiety disorders had a decreased risk of death with COVID-19 in epoch 2, 3, and 5 (aHR from 0.78 [95% CIs, 0.69, 0.88] to 0.89 [95% CIs, 0.81, 0.98]) and all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 0.83 [95% CIs, 0.77, 0.90] to 0.88 [95% CIs, 0.83, 0.93]). People diagnosed and treated for affective disorders had a decreased risk of both death with COVID-19 and from all-causes in epoch 3 (aHR from 0.87 [95% CIs, 0.79, 0.96] to 0.90 [95% CIs, 0.83, 0.99]), but demonstrated broadly null effects in other epochs. Given the unavailability of data on a number of potentially influential confounders, particularly body mass index, tobacco smoking status, and socioeconomic status, part of the detected associations might be due to residual confounding. CONCLUSIONS: People with preexisting psychotic, and, less robustly, substance use disorders demonstrated a persistently elevated risk of death following SARS-CoV-2 infection throughout the pandemic. While it cannot be ruled out that part of the detected associations is due to residual confounding, this excess mortality cannot be fully explained by lower vaccination uptake and more clinically recorded physical comorbidities in these patient groups.

• MeSH
• Betacoronavirus MeSH
• COVID-19 * mortality   epidemiology   complications   MeSH
• Adult MeSH
• Mental Disorders * epidemiology   MeSH
• Cohort Studies MeSH
• Comorbidity MeSH
• Coronavirus Infections mortality   epidemiology   complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pandemics * MeSH
• Cause of Death MeSH
• Registries MeSH
• SARS-CoV-2 * MeSH
• Aged MeSH
• Pneumonia, Viral mortality   epidemiology   complications   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Východiska: Histiocytózy jsou dle WHO klasifikace vzácné choroby charakterizované akumulací makrofágů a dendritických buněk nebo buněk odvozených z monocytů v různých orgánech a tkáních. Histiocytární choroby se vyskytují jak u dětí, tak u dospělých. Jejich klinická manifestace a morfologické formy jsou obvykle velmi divergentní. Histiocytózy je možné klasifikovat jak dle WHO klasifikace, poslední verze byla zveřejněna v roce 2022, tak dle klasifikace Histiocyte Society s poslední verzí z roku 2016. Cíl: V textu přikládáme přehled histiocytóz dle WHO klasifikace z roku 2022.

Background: Histiocytoses are rare disorders characterized by the accumulation of macrophages, dendritic cells, or monocyte-derived cells in various tissues and organs of children and adults, with a wide range of clinical manifestations, presentations, and histology. The histiocytoses are classified according to the WHO Classification, the last version of which was published in 2022, or according to the Histiocyte Society Classification, with the last version published in 2016. Purpose: This text provides an overview of histiocytoses as described in the WHO Classification 2022.

• MeSH
• Erdheim-Chester Disease drug therapy   pathology   MeSH
• Histiocytic Sarcoma classification   pathology   MeSH
• Histiocytosis, Langerhans-Cell classification   complications   pathology   therapy   MeSH
• Histiocytosis * classification   pathology   therapy   MeSH
• Humans MeSH
• Lymphatic Diseases * classification   pathology   therapy   MeSH
• Lymphohistiocytosis, Hemophagocytic drug therapy   classification   physiopathology   pathology   MeSH
• Pneumothorax etiology   therapy   MeSH
• Histiocytosis, Sinus drug therapy   classification   pathology   MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH