AIMS: Cardiac resynchronization therapy (CRT) is guideline recommended for the treatment of symptomatic heart failure (HF) with reduced left ventricular ejection fraction and prolonged QRS. However, patients with common comorbidities, such as persistent/permanent atrial fibrillation (AF), are often under-represented in clinical trials. METHODS: The Strategic Management to Optimize Response to Cardiac Resynchronization Therapy (SMART) registry (NCT03075215) was a global, multicentre, registry that enrolled de novo CRT implants, or upgrade from pacemaker or implantable cardioverter defibrillator to CRT-defibrillator (CRT-D), using a quadripolar left ventricular lead in real-world clinical practice. The primary endpoint was CRT response between baseline and 12 month follow-up defined as a clinical composite score (CCS) consisting of all-cause mortality, HF-associated hospitalization, New York Heart Association (NYHA) class and quality of life global assessment. RESULTS: The registry enrolled 2035 patients, of which 1558 had completed CCS outcomes at 12 months. The patient cohort was 33.0% female, mean age at enrolment was 67.5 ± 10.4 years and the mean left ventricular ejection fraction was 29.6 ± 7.9%. Notably, there was a high prevalence of mildly symptomatic patients (NYHA class I/II 51.3%), non-left bundle branch block (LBBB) morphology (38.0%), AF (37.2%) and diabetes mellitus (34.7%) at baseline. CCS at 12 months improved in 58.9% (n = 917) of patients; 20.1% (n = 313) of patients stabilized and 21.0% (n = 328) worsened. Several patient characteristics were associated with a lower likelihood of response to CRT including older age, ischaemic aetiology, renal dysfunction, AF, non-LBBB morphology and diabetes. Higher HF hospitalization (P < 0.001) and all-cause mortality (P < 0.001) were observed in patients with AF. These patients also had lower percentages of ventricular pacing than patients in sinus rhythm at baseline and follow-up (P < 0.001, both). A further association between AF and non-LBBB was observed with 81.4% of AF non-LBBB patients experiencing an HF hospitalization compared with 92.5% of non-AF LBBB patients (P < 0.001). Mortality between subgroups was also statistically significant (P = 0.019). CONCLUSIONS: This large, global registry enrolled a CRT-D population with higher incidence of comorbidities that have been historically underrepresented in clinical trials and provides new insight into factors influencing response to CRT. As defined by CCS, 58.9% of patients improved and 20.1% stabilized. Patients with AF had particularly worse clinical outcomes, higher HF hospitalization and mortality rates and lower percentages of ventricular pacing. High incidence of HF hospitalization in patients with AF and non-LBBB in this real-world cohort suggests that ablation may play an important role in increasing future CRT response rates.

• MeSH
• celosvětové zdraví MeSH
• funkce levé komory srdeční * fyziologie   MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• registrace * MeSH
• senioři MeSH
• srdeční resynchronizační terapie * metody   MeSH
• srdeční selhání * terapie   patofyziologie   mortalita   MeSH
• tepový objem * fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: A variable proportion of non-responders to cardiac resynchronization therapy (CRT) warrants the search for new approaches to optimize the position of the left ventricular (LV) lead and the CRT device programming. CineECG is a novel ECG modality proposed for the spatial visualization and quantification of myocardial depolarization and repolarization sequences. OBJECTIVE: The present study aimed to evaluate CineECG-derived parameters in different pacing modes and to test their associations with acute hemodynamic responses in CRT patients. METHODS AND RESULTS: CineECG was used to construct the average electrical path within the cardiac anatomy from the 12-lead ECG. CineECG and LV dP/dt max were tested in 15 patients with nonischemic dilated cardiomyopathy and left bundle branch block (QRS: 170 ± 17 ms; LVEF: 26 ± 5.5%) under pacing protocols with different LV lead localizations. The CineECG-derived path directions were computed for the QRS and ST-T intervals for the anteroposterior (Xh), interventricular (Yh), and apicobasal (Zh) axes. In a multivariate linear regression analysis with adjustment for the pacing protocol type, the ST-T path direction Yh was independently associated with the increase in dP/dt max during CRT, [regression coefficient 639.4 (95% confidence interval: 187.9-1090.9), p = 0.006]. In ROC curve analysis, the ST-T path direction Yh was associated with the achievement of a 10% increase in dP/dt max (AUC: 0.779, p = 0.002) with the optimal cut-off > 0.084 (left-to-right direction) with sensitivity 0.67 and specificity 0.92. CONCLUSION: The acute hemodynamic response in CRT patients was associated with specific CineECG repolarization sequence parameters, warranting their further testing as potential predictors of clinical outcomes.

• MeSH
• akční potenciály MeSH
• blokáda Tawarova raménka * patofyziologie   terapie   diagnóza   MeSH
• časové faktory MeSH
• dilatační kardiomyopatie patofyziologie   terapie   diagnóza   MeSH
• elektrokardiografie * MeSH
• funkce levé komory srdeční * MeSH
• hemodynamika * MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů * MeSH
• prostředky srdeční resynchronizační terapie MeSH
• senioři MeSH
• srdeční frekvence MeSH
• srdeční resynchronizační terapie * MeSH
• srdeční selhání patofyziologie   terapie   diagnóza   MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP). OBJECTIVE: The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT. METHODS: Consecutive patients who underwent BVP or CSP with HFmrEF between January 2018 and June 2023 at 16 international centers were included. The primary outcome was the composite end point of time to death or heart failure hospitalization (HFH). Secondary end points included change in left ventricular ejection fraction (LVEF) and individual end points of death and HFH. RESULTS: A total of 1004 patients met inclusion criteria: BVP, 178; CSP, 826 (His bundle pacing, 154; left bundle branch area pacing, 672). Mean age was 73 ± 13 years; female, 34%; and LVEF, 42% ± 5%. Paced QRS duration in CSP was significantly narrower compared with BVP (129 ± 21 ms vs 144 ± 19 ms; P < .001). LVEF improved during follow-up in both groups (49% ± 10% vs 48% ± 10%; P = .32). CSP was independently associated with significant reduction in the primary end point of time to death or HFH compared with BVP (22% vs 34%; hazard ratio, 0.64; 95% confidence interval, 0.43-0.94; P = .025). CONCLUSION: CSP was associated with improved clinical outcomes compared with BVP in this large cohort of patients with HFmrEF undergoing CRT. Randomized controlled trials comparing CSP with BVP will be necessary to confirm these results.

• MeSH
• blokáda Tawarova raménka terapie   patofyziologie   MeSH
• funkce levé komory srdeční * fyziologie   MeSH
• Hisův svazek patofyziologie   MeSH
• lidé MeSH
• následné studie MeSH
• převodní systém srdeční * patofyziologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• srdeční resynchronizační terapie * metody   MeSH
• srdeční selhání * terapie   patofyziologie   MeSH
• studie případů a kontrol MeSH
• tepový objem * fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• srovnávací studie MeSH

INTRODUCTION: The aim of our study was to study the association between end-of-surgery facial nerve stimulation threshold and extent of tumor resection in case of grade IV vestibular schwannomas. MATERIALS AND METHODS: Grade IV VSs represent a surgical challenge as a risk/benefit ratio must be considered in balancing a satisfactory extent of resection against a good postoperative functional outcome. We reviewed a cumulative series of 57 patients with large/giant VSs who were operated on by retrosigmoid approach in the period from 2008 to 2018 in two European centers, namely San Filippo Neri Hospital, Rome, Italy and Masaryk Hospital, Usti nad Labem, Czech Republic. Extent of resection, intraoperative direct electrical stimulation threshold of facial nerve and postoperative facial outcome were examined. RESULTS: Total or near-total resection was accomplished in 40 (75.5%) cases. Two groups were compared: total or near-total resection (T + NT) and subtotal resection (ST); the end-of-surgery facial nerve stimulation threshold significantly differed (T + NT: 0.24 mA, ST: 0.44 mA, p = 0.036). A critical cutoff was found at 0.2mA; values similar or inferior to this correctly predicted total or near-total resection in 86.7% of cases. Thirty (56.6%) patients had a normal postoperative facial outcome (HB1). Among the 40 patients in T + NT group, 32 (80%) retained an acceptable facial function (HB1-2). CONCLUSIONS: Lower facial nerve stimulation thresholds positively predict a broader extent of resection and total or -near total resection should be accomplished in such cases. Judicious (subtotal) resection is preferred if threshold values increase while dissecting firmly adherent tumors.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nervus facialis patofyziologie   MeSH
• neurochirurgické výkony * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stupeň nádoru MeSH
• vestibulární schwannom * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND AND OBJECTIVES: En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy. METHODS: Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy). RESULTS: The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements. CONCLUSION: The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.

• MeSH
• křížová kost * chirurgie   anatomie a histologie   inervace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míšní kořeny * anatomie a histologie   chirurgie   MeSH
• mrtvola * MeSH
• senioři MeSH
• splanchnické nervy anatomie a histologie   chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The radial nerve (RN) is a peripheral nerve that originates from the posterior bundle of the brachial plexus and carries C5-Th1 fibres. In the cubital fossa, the radial nerve divides into a superficial branch of the radial nerve (SBRN) and a deep branch of the radial nerve (DBRN). Next, the DBRN enters under the arcade of Frohse (AF) and changes its name to posterior interosseous nerve of antebrachii (PIN). The AF, first described in 1908 by Frohs and Frankel, is the superior proximal part of the supinator muscle, which can be tendinous or membranous. MATERIALS AND METHODS: Eight dissected upper limbs were examined to measure the distances and characteristics of the RN, DBRN, SBRN and AF, using a precise electronic caliper. RESULTS: The average distance from the point of branching of the RN into its terminal branches to the AF was 54.64 mm. In half of the cases, the DBRN divided before entering the AF. The average distance from the point of branching of the DBRN to the AF in these cases was 13.88 mm. The average width of the AF was 8.60 mm. Five tendinous AF and three membranous AF were identified. CONCLUSIONS: A thorough understanding of the anatomy of the radial nerve and its branches in the cubital fossa, as well as the AF, is important for the proper understanding of anatomy, and may also contribute to the reduction of surgical complications during procedures in this area.

• MeSH
• lidé MeSH
• mrtvola * MeSH
• nervus radialis * anatomie a histologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

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.

Background: Advances in the field of facial reanimation surgery have resulted in an increase in the quantity of published research in the international literature. The aim of this work is to provide the reader a synthesized view of the most influential themes, articles and authors in this field. Material and methods: We searched the Clarivate Analytics Web of Science Citation Index to identify the 50 most cited papers in dynamic facial reanimation in the past 70 years. Data regarding article title, authors, year of publication, total citations and citation index was obtained. Results are presented using descriptive statistics. Results: The most cited articles were distributed in 16 journals. Plastic and Reconstructive Surgery had the highest number of highly cited works with 27 articles, followed by JPRAS (5 papers) and the Journal of Neurosurgery (4 papers). The United States contributed most (17 papers), followed by Canada and Japan (6 each). Dr. Julia K. Terzis was the most cited author (7 works). Case series and comparative studies were the most prevalent type of article published (96%) from 1953 to 2015. The most cited paper focused on free functional muscle transfer (FFMT). Most articles were level IV research, with a mean citation index of 5.27 ± 2.85. Conclusion: This collection offers a clear overview of the key milestones and advancements in the field. We expect it serves as a practical resource for clinicians and researchers striving to advance the science and practice of facial reanimation surgery.

• MeSH
• anatomická značka * chirurgie   MeSH
• bibliometrie MeSH
• faciální paralýza chirurgie   MeSH
• lidé MeSH
• nervový transfer metody   MeSH
• nervus facialis chirurgie   MeSH
• rytidoplastika * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• systematický přehled MeSH

This study presents a combined experimental and numerical investigation of fiber transport and deposition in a realistic model of the female respiratory tract, extending to the seventh generation of branching. Numerical simulations were performed using the Euler-Lagrange Euler-Rotation (ELER) method, an efficient alternative to conventional Finite Volume Methods that benefits from explicit formulation and vast scalability, enabling fast parallelization on high-performance clusters. The ELER method was coupled with the Lattice Boltzmann Method (LBM) to simulate fiber dynamics under a realistic inspiratory flow profile. Experimental validation was conducted using an identical physical airway replica. The results demonstrated good agreement between simulations and experiments in the upper airways and trachea, with some discrepancies in the bifurcations, likely owing to the challenges of modeling complex turbulent flow with ELER. This method is more accurate than corresponding effective diameter simulations. Deposition patterns were analyzed as a function of fiber dimensions, revealing higher accuracy of the ELER method for smaller particles and confirming the tendency of higher aspect ratio fibers to penetrate deeper into the lungs. The orientation-dependent deposition mechanism was deployed, underscoring the importance of solving the actual orientations of the fibers. While advancing our understanding of fiber transport in female airways, the findings also reveal limitations in current numerical techniques, particularly in bifurcations. This study emphasizes the distinct behavior of fibrous versus spherical particles, with fibers exhibiting a greater propensity to reach deeper lung regions, which has significant implications for inhalation toxicology and drug delivery.

• MeSH
• aplikace inhalační MeSH
• biologické modely * MeSH
• dýchací soustava * MeSH
• lidé MeSH
• plíce MeSH
• počítačová simulace MeSH
• trachea * fyziologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1-4). The mean distance of the most distal branch was 35 mm (range 26-40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16-26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm.Level of evidence: V.

• MeSH
• arteria ulnaris * chirurgie   MeSH
• chirurgické laloky * krevní zásobení   MeSH
• kosterní svaly * krevní zásobení   MeSH
• lidé MeSH
• mrtvola * MeSH
• nervus medianus chirurgie   MeSH
• předloktí * chirurgie   krevní zásobení   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH