BACKGROUND: Various explicit screening tools, developed mostly in central Europe and the USA, assist clinicians in optimizing medication use for older adults. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria set, primarily based on the STOPP/START criteria set, is a current explicit tool originally developed for Eastern Europe and subsequently validated for broader use in Central European settings. Reviewed every three months to align with the latest scientific literature, it is one of the most up-to-date tools available. The tool is accessible via a free mobile app and website platforms, ensuring convenience for clinicians and timely integration of updates as needed. Healthcare providers often prefer to use their native language in medical practice, highlighting the need for prescribing tools to be translated and adapted into multiple languages to promote optimal medication practices. OBJECTIVE: To describe the protocol for cross-cultural and language validation of the TIME criteria in various commonly used languages and to outline its protocol for clinical validation across different healthcare settings. METHODS: The TIME International Study Group comprised 24 geriatric pharmacotherapy experts from 12 countries. In selecting the framework for the study, we reviewed the steps and outcomes from previous research on cross-cultural adaptations and clinical validations of explicit tools. Assessment tools were selected based on both their validity in accurately addressing the relevant issues and their feasibility for practical implementation. The drafted methodology paper was circulated among the study group members for feedback and revisions leading to a final consensus. RESULTS: The research methodology consists of two phases. Cross-cultural adaptation/language validation phase follows the 8-step approach recommended by World Health Organization. This phase allows regions or countries to make modifications to existing criteria or introduce new adjustments based on local prescribing practices and available medications, as long as these adjustments are supported by current scientific evidence. The second phase involves the clinical validation, where participants will be randomized into two groups. The control group will receive standard care, while the intervention group will have their treatment evaluated by clinicians who will review the TIME criteria and consider its recommendations. A variety of patient outcomes (i.e., number of hospital admissions, quality of life, number of regular medications [including over the counter medications], geriatric syndromes and mortality) in different healthcare settings will be investigated. CONCLUSION: The outputs of this methodological report are expected to promote broader adoption of the TIME criteria. Studies building on this work are anticipated to enhance the identification and management of inappropriate medication use and contribute to improved patient outcomes.

• MeSH
• lidé MeSH
• nevhodné předepisování statistika a číselné údaje   prevence a kontrola   MeSH
• senioři MeSH
• seznam potenciálně nevhodných léčiv * MeSH
• srovnání kultur MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA1c targets have been set. The aim of this study was to perform a longitudinal analysis of HbA1c, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries. METHODS: In this longitudinal analysis, we obtained data from the Australasian Diabetes Data Network, Czech National Childhood Diabetes Register, Danish Registry of Childhood and Adolescent Diabetes, Diabetes Prospective Follow-up Registry, Norwegian Childhood Diabetes Registry, England and Wales' National Paediatric Diabetes Audit, Swedish Childhood Diabetes Registry, T1D Exchange Quality Improvement Collaborative, and the SWEET initiative. All children (aged ≤18 years) with type 1 diabetes with a duration of longer than 3 months were included. Investigators compared data from 2013 to 2022; analyses performed on data were pre-defined and conducted separately by each respective registry. Data on demographics, HbA1c, treatment regimen, and event rates of diabetic ketoacidosis and severe hypoglycaemia were collected. ANOVA was performed to compare means between registries and years. Joinpoint regression analysis was used to study significant breakpoints in temporal trends. FINDINGS: In 2022, data were available for 109 494 children from the national registries and 35 590 from SWEET. Between 2013 and 2022, the aggregated mean HbA1c decreased from 8·2% (95% CI 8·1-8·3%; 66·5 mmol/mol [65·2-67·7]) to 7·6% (7·5-7·7; 59·4mmol/mol [58·2-60·5]), and the proportion of participants who had achieved HbA1c targets of less than 7% (<53 mmol/mol) increased from 19·0% to 38·8% (p<0·0001). In 2013, the aggregate event rate of severe hypoglycaemia rate was 3·0 events per 100 person-years (95% CI 2·0-4·9) compared with 1·7 events per 100 person-years (1·0-2·7) in 2022. In 2013, the aggregate event rate of diabetic ketoacidosis was 3·1 events per 100 person-years (95% CI 2·0-4·8) compared with 2·2 events per 100 person-years (1·4-3·4) in 2022. The proportion of participants with insulin pump use increased from 42·9% (95% CI 40·4-45·5) in 2013 to 60·2% (95% CI 57·9-62·6) in 2022 (mean difference 17·3% [13·8-20·7]; p<0·0001), and the proportion of participants using continuous glucose monitoring (CGM) increased from 18·7% (95% CI 9·5-28·0) in 2016 to 81·7% (73·0-90·4) in 2022 (mean difference 63·0% [50·3-75·7]; p<0·0001). INTERPRETATION: Between 2013 and 2022, glycaemic outcomes have improved, parallel to increased use of diabetes technology. Many children had HbA1c higher than the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 target. Reassuringly, despite targeting lower HbA1c, severe hypoglycaemia event rates are decreasing. Even for children with type 1 diabetes who have access to specialised diabetes care and diabetes technology, further advances in diabetes management are required to assist with achieving ISPAD glycaemic targets. FUNDING: None. TRANSLATIONS: For the Norwegian, German, Czech, Danish and Swedish translations of the abstract see Supplementary Materials section.

• MeSH
• diabetes mellitus 1. typu * epidemiologie   krev   farmakoterapie   MeSH
• dítě MeSH
• glykovaný hemoglobin * analýza   MeSH
• hypoglykemie epidemiologie   MeSH
• hypoglykemika * terapeutické užití   MeSH
• kojenec MeSH
• krevní glukóza * analýza   MeSH
• lidé MeSH
• longitudinální studie MeSH
• mladiství MeSH
• předškolní dítě MeSH
• registrace * statistika a číselné údaje   MeSH
• regulace glykemie statistika a číselné údaje   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

High soil pH and excess CaCO3 are major contributors to calcareous soil limitations on crops' access to essential nutrients, especially phosphorus (P) and micronutrients, which in turn impact pulses yields and growth. The purpose of this study was to determine the effect of bio sulfur granules (BSG) on the growth of black gram and the availability of nutrients in calcareous vertisols deficient in sulfur. BSG was developed by using sulfur-oxidizing bacteria (SOB) and elemental sulfur (ES) through an incubation study. Developed BSG was tested in a pot and field conditions to evaluate their effectiveness on black gram growth and yield. In the incubation study, soil treated with Methylobacterium thiocyanatum VRI7-A4 and ES (40 kg S/ha) significantly decreased pH and increased available S (SO42-) in calcareous soils. After 40 days of incubation, the solubility of P, Fe, and Zn was greatly increased by the addition of ES @ 40 kg S/ ha in combination with M. thiocyanatum VRI7-A4 or Pandoraea thiooxydans ATSB16. Black gram in S-deficient calcareous soil was improved by the application of BSG (ES @ 40 kg S/ ha with M. thiocyanatum VRI7-A7) in terms of root and shoot lengths, nodule number, plant biomass, pod yield, and biological yield as compared to control. The same treatment greatly increased plant nutrient intake as well as the concentrations of P, Fe, and Zn in the soil. The results showed that the addition of BSG granules (ES @ 40 kg S/ha + M. thiocyanatum VRI7-A4) to calcareous vertisol deficient in S enhanced the nutrient solubility through S oxidation. The developed bio sulfur granules may be added to the fertilizer schedule of the pulses growers to get improved crop growth and yield of black gram in calcareous soil.

• MeSH
• fosfor analýza   metabolismus   MeSH
• koncentrace vodíkových iontů MeSH
• Methylobacterium * metabolismus   MeSH
• půda * chemie   MeSH
• půdní mikrobiologie MeSH
• síra * metabolismus   MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: U idiopatické retroperitoneální fibrózy dominuje zavzetí ureterů do retroperitoneální fibrotické masy (zejména ve střední části ureterů), což vede k rozvoji (dolicho-) megaureterů s následnou progredující renální insuficiencí. Levá strana bývá postižena dříve. Řešením je ovlivnění etiopatogeneze onemocnění (zejména kortikoidní léčba) a derivace horních cest močových. Je možné provést buď trvalý stenting obou ureterů se všemi svými nevýhodami, či jejich deliberaci, která se historicky prováděla otevřeně ze střední laparotomie, nověji miniinvazivně. V práci hodnotíme výsledky miniinvazivní (laparoskopické, resp. roboticky asistované) deliberace a prezentujeme video robotické varianty. Soubor: V období 2001–2024 bylo k oboustranné deliberaci indikováno devět nemocných – tři muži (33 %) a šest žen; průměrný věk 58,5 ± 6,9 (48,8–69,6) roků; body mass index (BMI) 28,9 ± 5,8 (19,5–38,1). První čtyři řešení laparoskopicky, pět poté roboticky asistovaně. U dvou (22,2 %) nemocných nebylo možno uretery z těžkých fibrotických změn uvolnit (jeden z laparoskopie ponechán na stentech, druhý řešený roboticky asistovaně, provedena otevřená nefrektomie u ledviny s 8,6 % funkce a otevřená druhostranná deliberace – ze střední laparotomie). Doba operace obou stran (bez otevřeného výkonu) byla 154,0 ± 33,5 (100–201) min. Video: Ukazuje deliberaci obou ureterů roboticky asistovaně. Je užit čtyřramenný systém da Vinci Xi, poloha na boku 70°. Začínáme postiženější levou stranou. S Veres jehlou vytvořeno kapnoperitoneum tlakem 12 mm Hg, pupkem zaveden asistentský port 11 mm, za kontroly zraku zavedeny čtyři robotické 8mm porty. Kamera 30°, ProGraspTM, bipolární grasper MarylandTM, monopolární nůžky. Otevřeno parakolicky peritoneum, nalezen ureter a deliberován od dolního pólu ledviny až pod ilické cévy. Pod deliberovaný močovod vloženo mediální peritoneum a fixováno k laterálnímu okraji stehem či Hem-o-lok® L klipy. Ponechán port v pupku, změněna poloha a identicky proveden výkon i vpravo. Dutina břišní nedrénována. Ureterální stenty odstraněny za 3–6 týdnů. Výsledky: U 8 nemocných, kde bylo možno uretery deliberovat (15 močovodů, z toho 1 otevřeně), je známo dlouhodobé sledování všech 15 močovodů, u nich není nutný další stenting ureterů, horní cesty močové jsou sonograficky bez dilatace a nedochází k rozvoji renální insuficience. Doba sledování je v průměru 63,9 ± 64,3 (1–158) měsíců. U 8 kombinováno s kortikoidní terapií, která vedla vždy k výrazné regresi fibrotických hmot. Závěr: Deliberace močovodů při morbus Ormond je proveditelná miniinvazivně (laparoskopicky či roboticky asistovaně) u 77,8 % s překvapivě dobrými dlouhodobými výsledky umožňujícími uchránit horní cesty močové a vyhnout se dlouhodobému stentingu (ve 100 %). Robotické variantě dáváme nyní jednoznačně přednost.

Introduction: In idiopathic retroperitoneal fibrosis, ureteral involvement of the retroperitoneal fibrotic mass (especially in the middle part of the ureters) dominates, leading to the development of (dolicho-) megaureters with subsequent progressive renal insufficiency. The left side tends to be affected earlier. The solution is to influence the etiopathogenesis of the disease (especially corticoid treatment) and diversion of the upper urinary tract. Either permanent stenting of both ureters with all its disadvantages or ureterolysis. Historically open via midline laparotomy, more recently minimally invasive. In this paper we evaluate the results of minimally invasive (laparoscopic or robotic assisted) ureterolysis. Abstract: Between 2001 and 2024, nine patients were indicated for bilateral ureterolysis. Three men (33%) and six women. Mean age 58.5±6.9 (48.8-69.6) years. Body mass index (BMI) 28.9±5.8 (19.5-38.1). First four laparoscopically, subsequent five robotic assisted. In two (22.2%) patients ureters could not be released from severe fibrotic changes (one laparoscopy left with stents, the other robotically assisted open nephrectomy in a kidney with 8.6% function and open secondary ureterolysis - via midline laparotomy). The bilateral operation time (without open surgery) was 154.0±33.5 (100-201) min. Video: Shows the robotic-assisted bilateral ureterolysis. The 4-arm daVinci Xi system is used, 70° lateral position. Starting with the more affected left side. With Veres needle, capnoperitonum pressure of 12 mmHg created, 11 mm assisted port inserted through umbilicus, four robotic 8mm introduced under visual control. Camera 30°, ProGraspTM, bipolar grasper MarylandTM, monopolar scissors. Paracolic peritoneum opened, ureter found and liberated from the lower pole of the kidney to below the iliac vessels. Medial peritoneum inserted under the deliberated ureter and fixed to the lateral margin with suture or Hem-o-lok® L clips. The port in the umbilicus was left, the position was changed and the procedure was performed identically on the right side. The abdominal cavity was not drained. Ureteral stents removed in 3-6 weeks. Results: In the eight patients where ureters could be liberated (15 ureters, 1 open), long-term follow-up is known for all 15 ureters, no further ureteral stenting is required, the upper urinary tract is sonographically free of dilatation and no renal insufficiency developed. The mean follow-up time is 63.9±64.3 (1-158) months. In eight cases, combined corticosteroid therapy always resulted in significant regression of fibrotic masses. Conclusion: Liberation of ureters in morbus Ormond is feasible minimally invasively (laparoscopically or robotically assisted) in 77.8% with surprisingly good long-term results allowing preservation of the upper urinary tract and avoiding long-term stenting (in 100%). The robotic option is now clearly preferred.

• MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• obstrukce močovodu chirurgie   MeSH
• retroperitoneální fibróza * komplikace   MeSH
• roboticky asistované výkony MeSH
• urologické chirurgické výkony MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• audiovizuální média MeSH

BACKGROUND: Type 2 diabetes and prediabetes represent significant global health challenges, with physical activity (PA) being essential for disease management and prevention. Despite the well-documented benefits, many individuals with (pre)diabetes remain insufficiently active. General practitioners (GP) provide an accessible platform for delivering interventions; however, integrating PA interventions into routine care is hindered by resource constraints. OBJECTIVES: The ENERGISED trial aims to address these barriers through an innovative GP-initiated mHealth intervention combining wearable technology and just-in-time adaptive interventions. METHODS: The ENERGISED trial is a pragmatic, 12-month, multicentre, randomised controlled trial, assessing a GP-initiated mHealth intervention to increase PA and reduce sedentary behaviour in patients with type 2 diabetes and prediabetes. The primary outcome is daily step count, assessed via wrist-worn accelerometry. The primary analysis follows the intention-to-treat principle, using mixed models for repeated measures. Missing data will be handled under the missing-at-random assumption, with sensitivity analyses exploring robustness through reference-based multiple imputation. The trial incorporates the estimand framework to provide transparent and structured treatment effect estimation. DISCUSSION: This statistical analysis plan outlines a robust approach to addressing participant non-adherence, protocol violations, and missing data. By adopting the estimand framework and pre-specified sensitivity analyses, the plan ensures methodological rigour while enhancing the interpretability and applicability of results. CONCLUSIONS: The ENERGISED trial leverages innovative mHealth strategies within primary care to promote PA in individuals with (pre)diabetes. The pre-specified statistical framework provides a comprehensive guide for analysing trial data and contributes to advancing best practices in behavioural intervention trials for public health. TRIAL REGISTRATION: ClinicalTrials.gov NCT05351359 . Registered on April 28, 2022.

• MeSH
• akcelerometrie MeSH
• cvičení * MeSH
• diabetes mellitus 2. typu * terapie   psychologie   diagnóza   MeSH
• fitness náramky MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• nositelná elektronika MeSH
• pragmatické klinické studie jako téma MeSH
• praktické lékařství * metody   MeSH
• prediabetes * terapie   psychologie   diagnóza   MeSH
• sedavý životní styl * MeSH
• telemedicína * statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

BACKGROUND: Effective diabetes management requires a multimodal approach involving lifestyle changes, pharmacological treatment, and continuous patient education. Self-management demands can be overwhelming for patients, leading to lowered motivation, poor adherence, and compromised therapeutic outcomes. In this context, digital health apps are emerging as vital tools to provide personalized support and enhance diabetes management and clinical outcomes. OBJECTIVE: This study evaluated the impact of the digital health application Vitadio on glycemic control in patients with type 2 diabetes mellitus (T2DM). Secondary objectives included evaluating its effects on cardiometabolic parameters (weight, BMI, waist circumference, blood pressure, and heart rate) and self-reported measures of diabetes distress and self-management. METHODS: In this 6-month, 2-arm, multicenter, unblinded randomized controlled trial, patients aged 18 years or older diagnosed with T2DM were randomly assigned (1:1) to an intervention group (IG) receiving standard diabetes care reinforced by the digital health app Vitadio or to a control group (CG) provided solely with standard diabetes care. Vitadio provided a mobile-based self-management support tool featuring educational modules, motivational messages, peer support, personalized goal setting, and health monitoring. The personal consultant was available in the app to provide technical support for app-related issues. The primary outcome, assessed in the intention-to-treat population, was a change in glycated hemoglobin (HbA1c) levels at 6 months. Secondary outcomes included changes in cardiometabolic measures and self-reported outcomes. Data were collected in 2 study centers: diabetologist practice in Dessau-Roßlau and the University of Dresden. RESULTS: Between November 2022 and June 2023, a total of 276 patients were screened for eligibility, with 149 randomized to in intervention group (IG; n=73) and a control group (CG; n=76). The majority of participants were male (91/149, 61%). The dropout rate at month 6 was 19% (121/149). While both groups achieved significant HbA1c reduction at 6 months (IG: mean -0.8, SD 0.9%, P<.001; CG: mean -0.3, SD 0.7%, P=.001), the primary confirmatory analysis revealed statistically significant advantage of the IG (adjusted mean difference: -0.53%, SD 0.15, 95% CI -0.24 to -0.82; P<.001; effect size [Cohen d]=0.67, 95% CI 0.33-1). Significant between-group differences in favor of the IG were also observed for weight loss (P=.002), BMI (P=.001) and systolic blood pressure (P<.03). In addition, Vitadio users experienced greater reduction in diabetes-related distress (P<.03) and obtained more pronounced improvements in self-care practices in the areas of general diet (P<.001), specific diet (P<.03), and exercise (P<.03). CONCLUSIONS: This trial provides evidence for the superior efficacy of Vitadio in lowering the HbA1c levels in T2DM patients compared to standard care. In addition, Vitadio contributed to improvements in cardiometabolic health, reduced diabetes-related distress, and enhanced self-management, highlighting its potential as an accessible digital tool for comprehensive diabetes management. TRIAL REGISTRATION: German Clinical Trials Registry DRKS00027405; https://drks.de/search/de/trial/DRKS00027405.

• MeSH
• diabetes mellitus 2. typu * krev   terapie   MeSH
• dospělí MeSH
• glykovaný hemoglobin analýza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mobilní aplikace * MeSH
• péče o sebe MeSH
• self-management MeSH
• senioři MeSH
• telemedicína 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
• randomizované kontrolované studie MeSH

OBJECTIVE: Early hypoglycaemia at the time of neonatal intensive care unit (NICU) admission is common in very/extreme preterm infants. This study aimed to determine whether buccal dextrose gel in the delivery room (DR) would improve rates of early hypoglycaemia in this population. DESIGN: Randomised, blinded, placebo-controlled trial. SETTING: Four level-3 and one level-2 neonatal units. PATIENTS: Inborn infants≤32+0 weeks gestational age (GA). INTERVENTIONS: Infants were randomised to 40% dextrose or placebo gel in the DR (≤29+0 GA: 0.5 mL gel, ≥29+1 GA: 1 mL gel). MAIN OUTCOME MEASURE: Hypoglycaemia (<1.8 mmol/L) measured at the time of first intravenous access at NICU admission. RESULTS: Between November 2020 and August 2022, the recruitment rate was slow (impacted by the requirement for antenatal consent). This fact, coupled with finite research resources, led to a decision to end recruitment early. Data analysis of 169 newborns (33% of target sample size) showed no significant difference in the frequency of the primary outcome between dextrose 24/84 (29%) and placebo 25/85 (29%) groups (OR 0.95; 95% CI 0.49 to 1.86; p=0.88). A post-hoc analysis indicated that the trial had a low (47% conditional power) chance of detecting a statistically significant benefit from the intervention (had the target sample been achieved). CONCLUSIONS: This study showed no evidence of benefit of 40% dextrose gel on rates of hypoglycaemia at NICU admission. Management of these vulnerable newborns should continue to focus on vascular access and commencement of dextrose-containing intravenous fluids as early as possible. TRIAL REGISTRATION NUMBER: NCT04353713.

• MeSH
• aplikace bukální MeSH
• gely MeSH
• gestační stáří MeSH
• glukosa * aplikace a dávkování   MeSH
• hypoglykemie * farmakoterapie   prevence a kontrola   MeSH
• jednotky intenzivní péče o novorozence MeSH
• krevní glukóza analýza   MeSH
• lidé MeSH
• nemoci nedonošenců * farmakoterapie   MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• porodní sály MeSH
• sladidla aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

INTRODUCTION: Acute ischemic stroke (AIS) is the second leading cause of death and one of the leading causes of long-term disability globally. Endovascular thrombectomy (EVT) has revolutionized treatment for large vessel occlusion (LVO), providing 20% increase in post-stroke functional independence compared to intravenous thrombolysis (IVT) alone. Despite its proven efficacy, EVT is underutilized. While it is suitable for at least 15-20% of AIS patients, its mean adoption ranges from less than 1% to 7% in different areas. AREAS COVERED: This review highlights key findings from pivotal randomized controlled trials and real-world data, focusing on patient selection criteria, advancements in thrombectomy devices, and procedural innovations. A comprehensive literature search was performed using PubMed, Scopus, EMBASE and the Cochrane Library for relevant randomized controlled trials and observational studies. EXPERT OPINION: Disparity in access to EVT requires strategic investments in healthcare systems and international multidisciplinary collaboration. Enhancing geographic coverage with thrombectomy-capable centers and optimizing prehospital triage systems are essential. Bridging the gap between treatment capability and real-world implementation is critical to improving global AIS outcomes.

• MeSH
• endovaskulární výkony * metody   MeSH
• ischemická cévní mozková příhoda * chirurgie   MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• trombektomie * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

This randomized controlled trial evaluated the effectiveness of two home-based, stand-alone inspiratory muscle training (IMT) modalities - inspiratory flow-resistive loading with biofeedback (IRFL) and mechanical threshold loading (MTL) - compared to a sham MTL group for improving inspiratory muscle performance and functional exercise capacity in COPD patients. Thirty-six COPD patients trained at home for 8 weeks under remote monitoring. Primary outcomes included inspiratory muscle performance assessed via the Test of Incremental Respiratory Endurance (TIRE), functional exercise capacity, lung function, and other COPD-related measures. Both the TIRE IRFL and MTL groups showed significant improvements in inspiratory muscle strength compared to the sham MTL group (p < 0.05). Additionally, the IRFL with biofeedback group demonstrated significant gains in inspiratory muscle work capacity and 6MWT distance compared to both the MTL and sham groups (p < 0.05). No adverse events were reported, and adherence to training protocols was high across all groups. This study supports home-based IMT as a feasible, effective stand-alone intervention for COPD patients, particularly for those who face barriers in accessing traditional pulmonary rehabilitation programs. TIRE IFRL showed superior benefits in enhancing inspiratory muscle function and overall functional exercise capacity compared to fixed-load IMT.

• MeSH
• biofeedback (psychologie) MeSH
• chronická obstrukční plicní nemoc * rehabilitace   patofyziologie   MeSH
• dechová cvičení * metody   MeSH
• dýchací svaly * patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• služby domácí péče MeSH
• svalová síla MeSH
• tolerance zátěže MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Aim: To present on video our current most used technique of robot-assisted resection of renal tumour (RR). Material: We performed 274 RRs between June 2020 and November 2024. Our technique is based on a modification of conventional laparoscopic renal resection, of which we performed 599 between August 2004 and May 2020. RRs currently account for over one third of the surgical procedures for kidney cancer at our institution. Laparoscopic (rarely robotic assisted) nephrectomy is almost as frequent. Open resection accounts for about 17% and open nephrectomy for slightly less. Open resections are mainly indicated for more complex tumours, for tumors with significant \"toxic\" fat capsule, and when combined with other procedures, mostly for intestinal malignancies. RR is routinely performed by two console surgeons, occasionally by two additional ones. Operation technique: General anaesthesia. Optional urinary catheter inserted. Lateral position 60-70°. Upper limbs extended in front, close together. Operative field prepared for eventual lumbotomy. Transperitoneal approach. The capnoperitoneum is created with a Veres needle, CO2 pressure 12 mmHg. Assist port 12 mm slightly lateral to the umbilicus. Four 8-mm robotic ports are inserted pararectally under visual control. Four-arm daVinci Xi robotic system is inserted. Ports craniocaudally: 1. ProGrasp, 2. bipolar grasper (bipolar forceps Maryland or more often fenestrated) or monopolar curved scissors (Hot shears) according to the operated side and the dominant hand of the operator, 3. camera 30°, 4. the second of the mentioned instruments from port 2. The scissors are alternated with a needle driver, usually the Large SutureCut needle driver. In the Toldt line, the peritoneum is opened, the colon is retracted medially, and the Gerota fascia is opened medially from the kidney. The necessary part of the kidney is dissected from the fat capsule for good access to the tumour. The tumour is verified sonographically with a drop-in probe inserted through the assistant port. Scissors can be used to mark the line of resection on the kidney. The ureter is verified and the hilar vessels are released. The artery(s) or necessary branch is bypassed with tubing and clamped with the SCANLAN® robotic endo-bulldog. Only in central tumours is the vein also clamped. Knowledge of the topographic anatomy of the vessels from two-phase CT angiography is very helpful at this stage. The effectiveness of ischemia is verified by Doppler; exceptionally (especially in selective clamping of the artery branches) by NIR imaging with FireFly® with administration of indocyanine green - Verdye® 1.25-2.5 mg. The tumour is resected with cold scissors with a rim of healthy tissue. Suturing of the base is performed with an absorbable self-anchoring barbed suture (V-Loc® 90, size 3-0, 1/2 needle 26 mm). The edges of the kidney are mattress sutured with another suture, tightened with Absolok® AP300 absorbable clips (polydioxanone PDS, size ML) - \"sliding clips\" technique. The second layer of the parenchyma is sewn with simple continuation stitches, mostly without continuous anchoring. For more superficial tumours, a straight suture of the parenchyma is

• MeSH
• laparoskopie MeSH
• lidé MeSH
• nádory ledvin * chirurgie   MeSH
• nefrektomie MeSH
• roboticky asistované výkony metody   MeSH
• Check Tag
• lidé MeSH