INTRODUCTION: Systemic targeted therapy options are commonly used in patients with metastatic renal cell carcinoma (mRCC). Histological verification is crucial for treatment of mRCC. AIM: Our aim was to evaluate an optimal location for percutaneous computed tomography‐guided biopsy in a diagnosis of suspected mRCC. MATERIALS AND METHODS: A total of 138 percutaneous biopsies for tumors ranging from 21 to 133 mm in diameter (median, 72 mm) were carried out in 134 patients with suspected mRCC over a 5‐year period. The biopsy location was variable, with kidney biopsy performed in 77 cases (55.8%), and other localizations (retroperitoneum, peritoneal cavity, liver, pelvis, pleural space, lung, mediastinum, chest or abdominal wall, and pancreas) in 61 cases (44.2%). RESULTS: As many as 288 biopsies (97.1%), yielded truepositive results, and 4 procedures (2.9%) yielded histologically falsenegative results that required confirmation through extended rebiopsy. RCC was the most common individual diagnosis (85.5%), with non‐RCC histology verified in 14.5% of cases. In total, 32 complications (23.2%) were confirmed, 2 of which were pneumothoraces, 29 were minor bleeding that needed only conservative management, and 1 case required angiography and embolization for hemorrhage treatment. While no significant relationship between the biopsy success and lesion localization (renal vs other) was found (P = 0.13), the relationship between complication rate and biopsy localization (renal vs other) was significant (P = 0.01). CONCLUSIONS: Lesion localization (renal vs other) was not relevant to histological accuracy of the biop‐ sies performed in patients with suspected mRCC. However, the biopsies of lesions outside the kidney had a lower complication rate.

• Publikační typ
• časopisecké články MeSH

Intervenční výkony pod kontrolou CT patří mezi nejnáročnější z hlediska radiační ochrany personálu. Intervenující lékař musí stát velice blízko u CT skeneru a při některých výkonech je nutné, aby držel ruce přímo v primárním svazku. Pomocí různých typů a umístnění dozimetrů byla analyzována radiační zátěž intervenujících. Následně byly zavedeny prostředky ochrany personálu před zářením - jako například snížení expozičních parametrů, využití konstrukce CT skeneru jako stínění a edukace radiologických asistentů s důrazem na využití softwarové ochrany. Z naměřených dat byla analyzována účinnost zavedených doporučení. Průměrnou radiační zátěž na výkon PRT v oblasti L5/S1 měřenou na rukou intervenujícího lékaře se za dobu měření v rámci optimalizace podařilo snížit až o 57 % ze 41,0 μSv na 17,6 μ Sv a průměrnou radiační zátěž měřenou na hrudníku intervenujícího lékaře až o 76 % z 5,0 μSv na 1,2 μSv.

Interventional procedures guided by CT are one of the most dangerous from the aspect of radiation protection. The radiologist performing interventional procedures must stand very close to CT scanner. Moreover, during some of the interventional procedures the radiologist has to hold his hand directly in the CT scanner beam. To acquire the radiation dose data needed for radiation protection analysis, various types of detectors and monitoring locations were used. Countermeasures like modifications of exposition parameters, the usage of CT scanner construction as shielding during the CT fluoroscopy, the education of technologists with an emphasis on software protection and others were presented and implemented to optimize the radiation protection of radiologists performing interventional procedures guided by CT fluoroscopy. From the data collected, the efficiency of implemented countermeasures was calculated. The average hand radiation dose during the PRT (L5/S1) intervention of interventional radiologists was decreased by 57% from 41.0 μSv to 17.6 μSv. The average hand radiation dose of interventional radiologists was decreased by 76% from 5.0 μSv to 1.2 μSv.

• MeSH
• dávka záření MeSH
• hodnocení rizik metody   MeSH
• ionizující záření MeSH
• lidé MeSH
• monitorování radiace metody   MeSH
• obsah radioaktivních látek v organizmu MeSH
• počítačová rentgenová tomografie * škodlivé účinky   MeSH
• radiační ochrana * metody   MeSH
• referenční standardy MeSH
• Check Tag
• lidé MeSH

• MeSH
• environmentální zdraví MeSH
• hygiena práce MeSH
• pracoviště MeSH
• pracovní expozice prevence a kontrola   MeSH
• pracovní výkon MeSH
• uzavřené prostory MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Hygiena. Lidské zdraví
• NLK Obory
• environmentální vědy
• pracovní lékařství
• hygiena

We define an optimal signal in parametric neuronal models on the basis of interspike interval data and rate coding schema. Under the classical approach the optimal signal is located where the frequency transfer function is steepest. Its position coincides with the inflection point of this curve. This concept is extended here by using Fisher information which is the inverse asymptotic variance of the best estimator and its dependence on the parameter value indicates accuracy of estimation. We compare the signal producing maximal Fisher information with the inflection point of the sigmoidal frequency transfer function.

• MeSH
• akční potenciály MeSH
• financování organizované MeSH
• neurony aferentní fyziologie   MeSH
• signální transdukce MeSH

• MeSH
• diagnostické zobrazování MeSH
• počítačová rentgenová tomografie MeSH
• Publikační typ
• příručky MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• radiologie, nukleární medicína a zobrazovací metody
• fyzika, biofyzika

Several models (concentration detectors and a flux detector) for coding of odor intensity in olfactory sensory neurons are investigated. Behavior of the system is described by different stochastic processes of binding the odorant molecules to the receptors and their activation. Characteristics how well the odorant concentration can be estimated from the knowledge of response, the number of activated neurons, are studied. The approach is based on the Fisher information and analogous measures. These measures of optimality are computed and applied to locate the odorant concentration which is most suitable for coding. The results are compared with the classical deterministic approach which judges the optimal odorant concentration via steepness of the input-output function.

• MeSH
• algoritmy MeSH
• čichové buňky fyziologie   MeSH
• financování organizované MeSH
• kinetika MeSH
• lidé MeSH
• modely neurologické MeSH
• odoranty MeSH
• receptory pachové fyziologie   MeSH
• signální transdukce MeSH
• statistické modely MeSH
• stochastické procesy MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH

BACKGROUND: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. METHODS: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. FINDINGS: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. INTERPRETATION: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. FUNDING: Australian Research Council and the Australian National Health and Medical Research Council.

• MeSH
• klimatické změny MeSH
• nízká teplota * MeSH
• teplota MeSH
• vysoká teplota * MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Austrálie MeSH

Analysis of bioactive lipids in adipose tissue could lead to better understanding of the pathogenesis of obesity and its complications. However, current MS methods are limited by a high content of triacylglycerols (TAGs), which markedly surpasses the amount of other lipids and suppresses their ionization. The aim of our study was thus to optimize the preanalytical phase of lipid analysis in adipose tissue, focusing in particular on less-abundant lipids. Next, the optimized method was used to describe the differences between epicardial and subcutaneous adipose tissues obtained from patients undergoing cardiac surgery. Lipids were extracted using a modified Folch method with subsequent detachment of TAGs by thin layer chromatography (TLC). The extracts with/without TAGs were analyzed by tandem LC/MS. The repeatability of the presented method expressed by the median of the coefficients of variation was 12/5% for analysis with/without TAGs separation, respectively. The difference in the relative abundance of TAGs gained with/without TLC was, on average, 19% and did not reach significance (p value > 0.05) for any identified TAG. The novel preanalytical step allowed us to detect 37 lipids, which could not have been detected without TAG separation, because their signal to noise ratio is <5 in current methods of untargeted lipidomics. These lipids belong predominately to ceramides, glycerophosphatidylserines, glycerophosphatidylinsitols, sphingomyelins, glycerophosphatidylcholines, glycerophosphatidylethanolamines, diacylglycerols. The two adipose tissue depots differed mainly in the following lipid classes: glycerophosphatidylcholines, glycerophosphatidylinositols, glycerophosphatidylethanolamine, and sphingomyelins. Moreover, other major lipids showed distinctly different distributions between the two adipose tissues. Among these, the changes in TAGs were the most striking, which correspond to previously published data describing the differences between omental and subcutaneous adipose tissue. Implementation of the TLC step for the elimination of TAGs was crucial for enhancing the MS detection limit of minor lipids in adipose tissue. The differences between the overall lipid profiles of subcutaneous and epicardial tissue reflect their different functions arising from their location.

• MeSH
• chromatografie kapalinová metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipidy analýza   MeSH
• nitrobřišní tuk chemie   MeSH
• perikard fyziologie   MeSH
• podkožní tuk chemie   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• tandemová hmotnostní spektrometrie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Nedostatek zdravotnických pracovníků je v současné době považován za závažný celosvětový problém. Vzhledem k očekávaným demografickým změnám se dá předpokládat ještě jeho další eskalace v budoucnu. Zabránění odchodu zkušených a kvalifikovaných sester z profese může být pro řešení tohoto problému klíčové. V současné době dostupná data naznačují, že důvodem rozhodnutí o změně profese u sester nemusí být pouze nedostatečné finanční ohodnocení nebo individuální charakteristiky sester, ale především velké množství faktorů týkajících se kvality jejich pracovního prostředí. Tyto faktory přitom mají vliv nejen na narůstající fluktuaci sester, ale také negativně ovlivňují kvalitu poskytované zdravotní péče. Řešení kvality pracovního prostředí zdravotnických pracovníků včetně sester se zdá být pro dosažení jejich optimálního počtu v budoucnu zásadní, stejně jako pro dosažení optimální úrovně kvality poskytované péče.

The shortage of healthcare workers is currently considered a serious global problem. This could be further escalated due to theexpected demographic changes in the future. Finding a solution how to prevent qualified and experienced nurses from leavingtheir profession may be critical. Currently available evidence suggests that the main reason for a decision to leave nursing maynot only be the level of remuneration or individual characteristics of nurses, but above all a large number of factors affecting thequality of work environment. Those factors influence not only the increasing nursing turnover but also affect negatively the qualityof the provided health care. Addressing the quality of the work environment seems to be essential in order to achieve optimalnumber of health care workers including nurses in the future, as well as to bring the quality of provided care to the optimal level.

• MeSH
• ekonomika nemocniční organizace a řízení   zákonodárství a právo   MeSH
• kvalita zdravotní péče ekonomika   klasifikace   trendy   MeSH
• lidé MeSH
• nezaměstnanost klasifikace   trendy   MeSH
• pracoviště klasifikace   organizace a řízení   MeSH
• pracovní uspokojení MeSH
• pracovní výkon klasifikace   MeSH
• pracovní zátěž klasifikace   MeSH
• statistika jako téma MeSH
• zaměstnanost metody   organizace a řízení   pracovní síly   MeSH
• zdravotní sestry v klinické praxi ekonomika   klasifikace   organizace a řízení   MeSH
• zdravotní sestry ekonomika   klasifikace   organizace a řízení   MeSH
• Check Tag
• lidé MeSH

AIMS: Right ventricular apical pacing has a detrimental effect on left ventricular (LV) function. More optimal pacing site may be found by invasive measurement of LV mechanical performance during pacing from different RV pacing sites. We aimed to investigate the effect of RV pacing lead location on invasive indices of LV mechanical performance. METHODS AND RESULTS: Patients undergoing catheter ablation for persistent atrial fibrillation were enrolled. Single-site endocardial pacing from the lateral LV region was periodically switched to pacing from the mapping catheter navigated to different RV sites within the three-dimensional electroanatomical RV map. SystIndex, DiastIndex, and PPIndex were defined as the ratio of LV dP/dtmax, LV dP/dtmin, and arterial pulse pressure during RV pacing to corresponding values from adjacent periods of LV pacing. Haemodynamic data were analysed in 18 RV segments created by dividing RV horizontally (basal, mid, and apical portion), vertically (inferior, mid, and superior portion) and frontally (septum and free wall). Eight patients (58 ± 7 years; 2 females; 26 ± 4 RV pacing sites per patient) were enrolled into the study. Compared with LV pacing, the best RV pacing values of SystIndex and DiastIndex were achieved in basal-mid-septal segment (+6.9%, P = 0.02 and +3.4%, P = 0.36, respectively) while the best PPIndex was obtained in superior-mid-septal segment of RV (+4.5%, P = 0.02). All indices were fairly concordant showing significant improvement of haemodynamics during RV pacing in the direction from free wall to septum, from apex to base, and from inferior to superior segments. CONCLUSION: The best LV mechanical performance was achieved by RV septal pacing in the non-apical mid-to-superior segments.

• MeSH
• časové faktory MeSH
• diastola * MeSH
• elektrofyziologické techniky kardiologické MeSH
• elektrokardiografie MeSH
• fibrilace síní diagnóza   patofyziologie   chirurgie   MeSH
• funkce levé komory srdeční * MeSH
• funkce pravé komory srdeční * MeSH
• kardiostimulace umělá metody   MeSH
• katetrizační ablace MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezikomorová přepážka patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• srdeční komory patofyziologie   MeSH
• systola * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH