BACKGROUND & AIMS: Despite strong evidence for improved preservation of donor livers by machine perfusion, longer post-transplant follow-up data are urgently needed in an unselected patient population. We aimed to assess long-term outcomes after transplantation of hypothermic oxygenated machine perfusion (HOPE)-treated donor livers based on real-world data (i.e., IDEAL-D stage 4). METHODS: In this international, multicentre, observational cohort study, we collected data from adult recipients of HOPE-treated livers transplanted between January 2012 and December 2021. Analyses were stratified by donation after brain death (DBD) and donation after circulatory death (DCD), sub-divided by their respective risk categories. The primary outcome was death-censored graft survival. Secondary outcomes included the incidence of primary non-function (PNF) and ischaemic cholangiopathy (IC). RESULTS: We report on 1,202 liver transplantations (64% DBD) performed at 22 European centres. For DBD, a total number of 99 benchmark (8%), 176 standard (15%), and 493 extended-criteria (41%) cases were included. For DCD, 117 transplants were classified as low risk (10%), 186 as high risk (16%), and 131 as futile (11%), with significant risk profile variations among centres. Actuarial 1-, 3-, and 5-year death-censored graft survival rates for DBD and DCD livers were 95%, 92%, and 91%, vs. 92%, 87%, and 81%, respectively (log-rank p = 0.003). Within DBD and DCD strata, death-censored graft survival was similar among risk groups (log-rank p = 0.26, p = 0.99). Graft loss due to PNF or IC was 2.3% and 0.4% (DBD), and 5% and 4.1% (DCD). CONCLUSIONS: This study shows excellent 5-year survival after transplantation of HOPE-treated DBD and DCD livers with low rates of graft loss due to PNF or IC, irrespective of their individual risk profile. HOPE treatment has now reached IDEAL-D stage 4, which further supports its implementation in routine clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05520320. IMPACT AND IMPLICATIONS: This study demonstrates the excellent long-term performance of hypothermic oxygenated machine perfusion (HOPE) treatment of donation after circulatory and donation after brain death liver grafts irrespective of their individual risk profile in a real-world setting, outside the evaluation of randomised-controlled trials. While previous studies have established safety, feasibility, and efficacy against the current standard, according to the IDEAL-D evaluation framework, HOPE treatment has now reached the final IDEAL-D stage 4, which further supports its implementation in routine clinical practice.

• MeSH
• dárci tkání statistika a číselné údaje   MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• perfuze * metody   přístrojové vybavení   MeSH
• přežívání štěpu * MeSH
• senioři MeSH
• terapeutická hypotermie metody   MeSH
• transplantace jater * metody   škodlivé účinky   MeSH
• uchovávání orgánů * metody   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
• pozorovací studie MeSH

INTRODUCTION: Despite the widespread use of the Movement Assessment Battery for Children, 2nd edition (MABC-2), little is known about the sensitivity or specificity of the individual items to detect probable Developmental Coordination Disorder (p-DCD). This study examined which specific MABC-2 items were most sensitive to identify children with p-DCD and which items would predict p-DCD. METHODS: Based on a large dataset including European and African children aged 3-16 years (n = 4916, typically developing (TD, 49.6 % boys); n = 822 p-DCD (53.1 % boys), Hedges' g was calculated to establish the standardized mean difference (SMD) between p-DCD/TD. SMDs were considered substantial when absolute values at or above 1.4. Sensitivity and specificity of the raw MABC-2 item scores predicting p-DCD/TD per age band (AB) were established with logistic regression analysis. RESULTS: AB1: Children with p-DCD performed substantially poorer on threading beads (SMD: -1.61) and jumping on mats (SMD: 1.61). By combining all items and the country of origin, the sensitivity was 61.7 % and specificity 98.6 %. AB2: Walking heel-to-toe forwards (SMD: 1.65) was substantially poorer in p-DCD. By combining all items and the country of origin, the sensitivity was 79.0 % and specificity 97.6 %. AB3: Catching a ball with the preferred (SMD: 1.8) or non-preferred (SMD: 1.61) hand, and for walking heel-to-toe backwards (SMD: 1.78) were substantially poorer in p-DCD. All items combined resulted in a sensitivity of 94.4 % and specificity of 99.6 %. CONCLUSION: Not all MABC-2 items are equally sensitive to distinguish between performances of p-DCD and TD. Despite the good specificity, the sensitivity was only moderate in AB1-2, the age at which children learn culturally influenced motor skills.

• MeSH
• dítě MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• motorické dovednosti MeSH
• pohyb MeSH
• poruchy motorických dovedností * diagnóza   MeSH
• předškolní dítě MeSH
• senzitivita a specificita * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Afrika MeSH
• Evropa MeSH

The present paper is designed to promote awareness of DCD outside the academic world. With a prevalence of 5-6% it is one of the most common disorders of child development. It is therefore surprising that so little is known about it among professionals in child healthcare and education. Parents have expressed frustration about this lack of awareness, including the general public. The general aim of this paper was to describe those critical aspects of DCD that will promote awareness.

• MeSH
• dítě MeSH
• lidé MeSH
• poruchy motorických dovedností * epidemiologie   MeSH
• prevalence MeSH
• rodiče MeSH
• stupeň vzdělání MeSH
• vývoj dítěte MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Children with developmental coordination disorder (DCD) show deficits in motor-cognitive coupling. However, it remains unclear whether such deficits depend on the severity of DCD. The aim of this study was to examine cognitive-motor coupling under different levels of inhibitory control in children with severe (s-DCD) or moderate DCD (m-DCD), compared with typically-developing children (TDC). The performance of 29 primary-school children aged 6-12 years with s-DCD (Mage = 9.12 ± 1.56 years), 53 m-DCD (Mage = 8.78 ± 1.67 years), and 201 TDC (Mage = 9.20 ± 1.50 years) was compared on a double jump reaching task (DJRT) paradigm, presented on a large 42-inch touchscreen. The task display had a circular home-base, centred at the bottom of the display, and three target locations at radials of -20°, 0°, and 20°, 40 cm above the home-base circle. For the standard double-jump reaching task (DJRT), children moved their index finger from home-base circle to touch the target stimulus as fast as possible; 20% were jump trials where the target shifted left or right at lift-off. For the anti-jump reaching task (AJRT), 20% of trials required an anti-jump movement, touching the contralateral target location. While no group differences were shown on the DJRT, the DCD group were slower to complete reaching movements than the TDC group on AJRT; on the latter, the two DCD sub-groups were not shown to differ. Results confirm the presence of motor inhibition deficits in DCD which may not be dependent on the motor severity of the disorder.

• Publikační typ
• časopisecké články MeSH

Cíl práce: Období pandemie covid-19 výrazně ovlivnilo zdravotnický systém, včetně dopadu na dodržování principů racionální antibiotické politiky, zejména v souvislosti s nozokomiálními pneumoniemi, kdy bylo velmi obtížné odlišit případnou bakteriální superinfekci od závažné zánětlivé reakce vyvolané virem SARS-CoV-2. Cílem předložené studie byla analýza antimikrobiální rezistence bakteriálních agens izolovaných z dolních cest dýchacích a jejich klonality u pacientů v intenzivní péči v roce 2022 a porovnání s předchozím covidovým obdobím. Materiál a metody: Do studie byly zahrnuty bakteriální kmeny izolované z dolních cest dýchacích (DCD) pacientů hospitalizovaných na Klinice anesteziologie, resuscitace a intenzivní medicíny Fakultní nemocnice Olomouc (KARIM) v období tří let (1. 1. 2020 – 31. 12. 2022). Citlivost k antibiotikům byla stanovena standardní diluční mikrometodou podle kritérií EUCAST, u vybraných izolátů bylo provedeno porovnání pomocí pulzní gelové elektroforézy (PFGE). Výsledky: Rezistence nejčastějších bakteriálních agens izolovaných z DCD pacientů hospitalizovaných na KARIM se během covidového (2020-2021) a pocovidového (2022) období výrazně nezměnila, s výjimkou Serratia marcescens a Enterococcus faecium. Tato dvě species vykázala nárůst počtu kmenů během pandemie covid-19 a rovněž významný vzestup podílu rezistentních kmenů. V případě Serratia marcescens došlo k následnému poklesu počtu izolátů i jejich rezistence v roce 2022. V případě Enterococcus faecium celkový počet izolátů rovněž významně klesl, ale četnost vankomycin-rezistentních izolátů (VRE) se nadále zvyšovala. V období pandemie covid-19 lze zvýšený záchyt VRE spojit s klonálním šířením, v roce 2022 se však výrazná klonalita již nepotvrdila. Porovnání podobnosti pomocí PFGE u dalších bakteriálních druhů rovněž neodhalilo významnější horizontální přenos mezi pacienty v pocovidovém období, neboť většina izolátů (85 %) vykazovala jedinečný restrikční profil. Závěr: Výsledky naznačují, že frekvence i antimikrobiální rezistence většiny nejčastějších bakteriálních agens z dolních cest dýchacích pacientů hospitalizovaných na KARIM v pocovidovém období zůstává srovnatelná s dobou před propuknutím pandemie covid-19 i během ní. Výjimkou je druh Enterococcus faecium, u něhož došlo k nárůstu rezistence k vankomycinu v kovidovém i pocovidovém období

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OBJECTIVE: To investigate whether observable differences exist between patterns of withdrawal of life-sustaining measures (WLSM) for patients eligible for donation after circulatory death (DCD) in whom donation was attempted compared with those patients in whom no donation attempts were made. SETTING: Adult intensive care units from 20 centres in Canada, the Czech Republic and the Netherlands. DESIGN: Secondary analysis of quantitative data collected as part of a large, prospective, cohort study (the Death Prediction and Physiology after Removal of Therapy study). PARTICIPANTS: Patients ≥18 years of age who died after a controlled WLSM in an intensive care unit. Patients were classified as not DCD eligible, DCD eligible with DCD attempted or DCD eligible but DCD was not attempted. PRIMARY AND SECONDARY OUTCOME MEASURES: The process of WLSM (timing and type and, if applicable, dosages of measures withdrawn, dosages of analgesics/sedatives) was compared between groups. RESULTS: Of the 635 patients analysed, 85% had either cardiovascular support stopped or were extubated immediately on WLSM. Of the DCD eligible patients, more were immediately extubated at the initiation of WLSM when DCD was attempted compared with when DCD was not attempted (95% vs 61%, p<0.0001). Initiation of WLSM with the immediate cessation of cardiovascular measures or early extubation was associated with earlier time to death, even after adjusting for confounders (OR 2.94, 95% CI 1.39 to 6.23, at 30 min). Other than in a few patients who received propofol, analgesic and sedative dosing after WLSM between DCD attempted and DCD eligible but not attempted patients was not significantly different. All patients died. CONCLUSIONS: Patients in whom DCD is attempted may receive a different process of WLSM. This highlights the need for a standardised and transparent process for end-of-life care across the spectrum of critically ill patients and potential organ donors.

• MeSH
• dospělí MeSH
• extubace MeSH
• hypnotika a sedativa MeSH
• jednotky intenzivní péče * MeSH
• kohortové studie MeSH
• lidé MeSH
• pacienti * MeSH
• prospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

This study aimed to identify time parameters predicting favourable CRT response. A total of 38 patients with ischemic cardiomyopathy, qualified for CRT implantation, were enrolled in the study. A 15% reduction in indexed end-systolic volume after 6 months was a criterion for a positive response to CRT. We evaluated QRS duration, measured from a standard ECG before and after CRT implantation and obtained from mapping with NOGA XP system (AEMM); and the delay, measured with the implanted device algorithm (DCD) and its change after 6 months (ΔDCD); and selected delay parameters between the left and right ventricles based on AEMM data. A total of 24 patients presented with a positive response to CRT versus 9 non-responders. After CRT implantation, we observed differences between responders and non-responders group in the reduction of QRS duration (31 ms vs. 16 ms), duration of paced QRS (123 ms vs. 142 ms), and the change of ΔDCDMaximum (4.9 ms vs. 0.44 ms) and ΔDCDMean (7.7 ms vs. 0.9 ms). The difference in selected parameters obtained during AEMM in both groups was related to interventricular delay (40.3 ms vs. 18.6 ms). Concerning local activation time and left ventricular activation time, we analysed the delays in individual left ventricular segments. Predominant activation delay of the posterior wall middle segment was associated with a better response to CRT. Some AEMM parameters, paced QRS time of less than 120 ms and reduction of QRS duration greater than 20 ms predict the response to CRT. ΔDCD is associated with favourable electrical and structural remodelling.Clinical trial registration: SUM No. KNW/0022/KB1/17/15.

• MeSH
• časové faktory MeSH
• elektrokardiografie MeSH
• lidé MeSH
• srdeční resynchronizační terapie * MeSH
• srdeční selhání * terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND Kidney donation after circulatory death (DCD) follows confirmation of death using cardiorespiratory criteria, while donation after brain death (DBD) uses neurological criteria. DBD and DCD donors are the main sources of grafts for transplantation. This retrospective cohort study from a single center in the Czech Republic aimed to compare 5-year post-transplantation outcomes after DCD and DBD transplantation without pre-mortem heparin administration. MATERIAL AND METHODS A total of 227 recipients with matched donors enrolled in the transplantation program at our institution between 2015 and 2019 were analyzed. Following the application of the inclusion criteria, 99 recipients and 94 matched donors were finally included in the study. RESULTS The duration of cold ischemia (median 961 vs 1100 min, P=0.028) and the perfusion with the preservation solution (median 11 vs 22 min, P<0.001) was statistically significantly shorter in DBD than in DCD grafts. The 1-year survival rates were 97.5% (95% CI 94.1-100.0%) and 90.0% (95% CI: 77.8-100.0%) for DBD and DCD recipients, respectively. The 3-year survival rates were 91.9 (95% CI: 86.0-98.4) and 90.0 (95% CI: 77.8-100.0) for the DBD and DCD groups, respectively. The overall difference in survival between the 2 groups of patients was not statistically significant (P=0.750) nor was disease-free survival (P=0.370). CONCLUSIONS This retrospective study from a single center showed similar 5-year results after kidney transplantation for DCD and DBD donors without pre-mortem heparin administration, including the time to graft failure and patient survival.

• MeSH
• heparin MeSH
• lidé MeSH
• mozková smrt * MeSH
• přežívání štěpu MeSH
• retrospektivní studie MeSH
• transplantace ledvin * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

V předkládaném přehledovém článku autoři článku představují legislativní úpravu týkající se rozdílu smrti mozku a nevratné zástavy oběhu (NHBD – non heart beating donor, DCD – donation after cardiac death), které jsou základním pilířem novely transplantačního zákona č. 44/2013 v České republice. Blíže popisují proces dárcovství DCD a kategorizaci dárců orgánů a tkání dle Maastrichtských kritérií. Zaměřují se na rozdílnost mezi diagnostikou smrti mozku a nevratnou zástavou oběhu. Problematiku znalostí personálu o možnostech odběru orgánů a tkání od dárců po nevratné zástavě oběhu a jeho základním legislativním rámci v České republice shrnují v závěru své práce.

In this review article, the authors present the legislative regulation regarding the difference between brain death and irreversible circulatory arrest (NHBD – non heart beating donor, DCD – donation after cardiac death), which are the main pillars of the amendment to the Transplantation Act No. 44/2013 in the Czech Republic. They describe in more detail the process of DCD donation and the categorization of organ and tissue donors according to the Maastricht criteria. They focus on the difference between the diagnosis of brain death and irreversible circulatory arrest. They summarize the issue of staff knowledge about the possibilities of organ and tissue procurement from donors after irreversible circulatory arrest and its basic legislative framework in the Czech Republic in the conclusion of their work.

• MeSH
• lidé MeSH
• mozková smrt * diagnóza   MeSH
• náhlá srdeční smrt MeSH
• odběr tkání a orgánů * etika   zákonodárství a právo   MeSH
• transplantace etika   zákonodárství a právo   MeSH
• zákonodárství lékařské MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH

Vývojová porucha koordinace (VPK) a její dlouhodobé důsledky jsou odborníky stále často opomíjeny. Projevuje se neobratností, poruchami rovnováhy, hrubé i jemné motoriky s často přidruženými obtížemi v jazyce, percepci a myšlení. Prevalence se v posledních dvou desetiletích stabilně odhaduje okolo 5–6 %, přičemž je známo, že v polovině případů přetrvávají motorické obtíže do dospělosti. Nízká porodní hmotnost či prematurita několikanásobně zvyšují riziko vzniku VPK. Pro screening mohou posloužit krátké testy hodnotící kvalitu pohybové koordinace, zatímco při stanovování diagnózy je vhodné využít standardizovanou testovací baterii s možností posouzení výsledků terapie opakovaným testováním. Byly zjištěny strukturální i funkční změny centrálního nervového systému, které podmiňují klinické projevy. Nejefektivnější terapeutické přístupy se zaměřují na nácvik provádění konkrétní deficitní činnosti. V rámci terapie jsou diskutovány konkrétní přístupy využívající poznatky o motorickém učení sloužící k zefektivnění terapeutického procesu, mezi něž paří nácvik pohybu v představě a externí orientace pozornosti.

Developmental coordination disorder (DCD) and its long term consequences are still often marginalised by professionals. The symptoms include poor coordination, balance issues, issues with gross and fine motor functions with often co-occurring impairment of speech, perception and cognitive functions. In the last two decades, the prevalence has been steadily estimated around 5–6%, although it is known that in approximately half of the cases, motor difficulties persist into adulthood. Prematurity and low birth weight causes a severalfold increase in the occurrence risk of DCD. Short tests assessing the quality of motor coordination can serve as a screening tool, whereas standardised test batteries are used for diagnosing with the possibility of re-testing during the therapeutic process. Structural and functional abnormalities of the central nervous system underlining the clinical symptoms have been described. The most effective therapeutic approaches target specific activities which are known to be deficient. Specific methods that use motor learning findings which lead to more efficient therapeutic process have been discussed, including motor imagery training and external focus of attention.

• Klíčová slova
• motorické učení, externí orientace pozornosti, pohyb v představě,
• MeSH
• dítě MeSH
• lidé MeSH
• orientace MeSH
• poruchy motorických dovedností * diagnóza   etiologie   terapie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH