University Hospital Ostrava

Objectives Subsequent to early life feeding issues, children with Prader–Willi syndrome (PWS) develop hyperphagia and severe obesity. Growth hormone (GH) therapy has been approved in PWS to improve growth, body composition, and BMI. We aimed to clarify the role of age at GH therapy onset on growth and BMI trajectories in children with PWS. Methods We analyzed height and BMI in 114 patients (58 boys) from REPAR – Czech national GH registry. From them, 69 started GH therapy prior to 2 y/o (age 0.8 ± 0.4 years; mean ± SD; early-onset group [EO]), and 45 later (age 7.1 ± 4.1 years; late-onset group [LO]). Results Height-SDS before therapy was similar in all (EO: −1.9 ± 1.2 [mean ± SD]; LO: −1.7 ± 1.1). After the first year of GH therapy, height-SDS in the EO group increased to −1.0 ± 1.2, in the LO group to −0.9 ± 1.1. After 5 years, height fully normalized in all (−0.1 ± 1.1 SDS). The LO children were already obese at treatment initiation (BMI-SDS: 2.9 ± 2.2), and their BMI-SDS decreased after 1 year of GH therapy by 0.9 (p=0.003). The weight in EO children was below average before GH treatment (BMI-SDS: −0.9 ± 1.2) and their BMI-SDS increased to the overweight range of 1.3 ± 2.2 (p<0.001) within the oncoming 3 years. Albeit BMI-SDS was around the obesity limit in most children after 5 years on GH therapy, the highest lifetime BMI-SDS was lower in EO (2.2 ± 2.6) than in LO (3.7 ± 2.2; p<0.001). Conclusions GH treatment in PWS normalizes body height. After 5 years of GH therapy, BMI-SDS in EO and LO groups are similar; however, the EO group is exposed to lower maximal BMI-SDS values.

Purpose This study aimed to assess the impact of positional changes on upper airway obstruction patterns during drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA) and identify the airway regions most responsive to this change. Special focus was placed on the tongue base, a critical area in OSA pathophysiology. Methods This prospective study was conducted from June 2021 to June 2024. DISE was performed in patients with obstructive sleep apnea (OSA) in supine and lateral positions to simulate the effect of positional therapy. Findings were evaluated using the VOTE classification. Results The examination was performed on 186 patients, with a median Apnea–Hypopnea Index (AHI) of 19.3. In the supine position, complete obstructions were noted at the soft palate (88.2%), oropharynx (33.3%), tongue base (53.2%), and epiglottis (15.6%). Lateral positioning significantly reduced obstructions, particularly at the tongue base, where obstruction resolved in 94/99 of cases (94.9%). This improvement was significantly more pronounced at the tongue base than at other sites (p < 0.001). Conclusion These results suggest that DISE can identify airway regions responsive to positional changes, potentially guiding clinical decisions on positional therapy. The findings show a significant reduction in tongue base obstruction during lateral positioning in DISE. Since tongue base obstruction is a key contributor to airway collapse in OSA, this improvement suggests a practical, non-invasive treatment approach. While these findings highlight an acute association between lateral positioning and reduced obstruction, further studies are needed to evaluate its long-term clinical efficacy.

Background This intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP). Materials and methods The local institutional review board approved this feasibility study. In three patients with RAP, after repeated good response, symptoms were temporarily relieved after anaesthetic blockade of the left SG under ultrasound guidance. Radiosurgical neuromodulation with a dose of 40 Gy in one fraction was used for more permanent pain control. When RAP recurred after the initial SRS, right-sided procedures were considered after a confirmed positive response to right SG anesthetic block. Results No acute or late radiation-related toxicities were observed. Two patients (67%) responded to bilateral SRS (follow-up: 60 and 48 months, respectively). From baseline to 24 months, their average prescribed nitrate package count decreased from 5.5 to 0 and remained low. Daily emergency nitrates declined from 20 to 30 to 1–2 applications, and walking distance improved from 10 to 20 m to 200–400 m and remained stable. Quality of life as measured with the EQ-5D and all domains of the Seattle Angina Questionnaire improved. The third patient received only unilateral SRS, had a temporary improvement for 6 months before a return to baseline, and died after 42 months of follow-up. Conclusions Bilateral radiosurgical neuromodulation at 40 Gy appears to be feasible, safe, and effective as a bailout procedure for RAP.

Introduction Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0–2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis. Results We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7–18) vs 5 (2–13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76–1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84–1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98–15.23]). PSM analysis revealed similar results. Discussion and conclusion In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.

Background Only limited epidemiological data exist from national or international prospective multicentre registries covering the whole spectrum of cardiogenic shock (CS) aetiologies. Methods CZECH-SHOCK was a national prospective multicentre observational study conducted in 15 main tertiary care centres in Czechia over a 12-month period from March 2023 to February 2024. Results A total of 418 patients with a median age of 70 (IQR 59-76) years were enrolled. The majority of patients were male (69.6%). A newly developed heart failure was observed in 76.8% patients, and acute myocardial infarction complicated by CS (AMI-CS) was the most frequent cause of a CS episode (56.7%). Mechanical circulatory support devices were utilised in 28.2% of cases. A 30-day mortality was 39.5%. In a multivariate analysis, six independent factors were associated with a higher 30-day mortality: age (OR per 10 year increase: 1.78, 95% CI: 1.45–2.19), history of coronary artery disease (OR: 2.38, 95% CI: 1.41–4.30), history of chronic obstructive pulmonary disease (OR: 2.58, 95% CI: 1.27–5.25), SCAI class on admission (OR per one class increase: 1.64, 95% CI: 1.27–2.11), renal replacement therapy during in-hospital stay (OR: 2.46, 95% CI: 1.32–4.59) and new mechanical ventilation after admission (OR: 4.58, 95% CI: 2.50–8.39). Conclusions AMI-CS still represents the most frequent cause of CS episodes. The in-hospital mortality of patients with CS remains high, despite frequent utilization of hemodynamic support and organ replacement therapies.

Purpose To evaluate the role of an anti-reflux diet in the treatment of patients with chronic cough caused by laryngopharyngeal reflux (LPR). Methods This prospective observational study included patients with chronic cough (lasting over 3 months) and laryngopharyngeal reflux (LPR) confirmed by hypopharyngeal-esophageal 24-h multichannel intraluminal impedance-pH monitoring (HEMII-pH), according to Dubai criteria. Participants were categorized based on cough severity using a visual analog scale (VAS) from 1 to 10. A VAS < 5 was considered to indicate mild cough, whereas a VAS ≥ 5 were considered to indicate severe cough. Patients with mild cough were treated by anti-reflux diet only, while those with severe cough received additional treatment with proton pump inhibitors (PPIs) and alginates. After 3 months, treatment effectiveness was evaluated by assessing the reduction in cough severity. Results In patients with mild cough, anti-reflux diet alone proved to be effective, yielding improvement in 83.3% of cases. Among patients with severe cough, a combination of anti-reflux diet, proton pump inhibitors (PPIs), and alginates proved was effective in 81.8% of cases. Conclusion Diet alone is an effective and sufficient treatment for mild chronic cough in patients with LPR. For patients with severe chronic cough with LPT, combined anti-reflux measures are effective.

Background Diabetes mellitus (DM) significantly impacts global health and economies. Despite various therapies, managing DM remains challenging. Bariatric surgery has shown efficacy in obese patients with type 2 diabetes mellitus (T2DM), but its utilization remains low. Innovative, less invasive endoscopic approaches such as duodenal mucosal resurfacing show potential in treating T2DM. This article presents the results of a First in Human (FIH) study using a duodenal submucosal laser ablation investigational device for T2DM treatment. Methods A prospective, single‐arm, open‐label study evaluated the safety and efficacy of the Digma System Endoscopic procedure for duodenal submucosal laser ablation in consecutive enrolled T2DM patients. Results The study was conducted from July 2017 to December 2020 and enrolled 31 patients for the Digma System Endoscopic procedure. The Dose Escalation Cohort (DEC) used sub‐therapeutic laser doses for training and safety. The Treatment Cohort (TC) of 25 patients received therapeutic doses, resulting in HbA1c reductions of −0.6% at 6 months (p = 0.014) and −0.4% at 12 months (p = 0.062). Fasting glucose dropped 17.3 mg/dL (p = 0.173) at 6 months and 28 mg/dL (p = 0.022) at 12 months. Post‐prandial glucose improvements were also observed. HOMA‐IR improved at 3 and 6 months. PAGI‐SYM and PAGI‐QOL showed stable to slightly improved GI symptoms and quality of life. Two severe adverse events were unrelated to the procedure. Conclusion The study demonstrates the safety, feasibility, and potential efficacy of the Digma System Endoscopic procedure. Evidence suggests improvements in HbA1c, fasting and post‐prandial glucose, and HOMA‐IR levels could be attributed to the Digma System Endoscopic procedure.

Malignant ascites (MA) and repeated paracentesis can impair a patient’s quality of life (QOL). The aim was to perform an interim analysis of safety and changes in patients’ QOL in an ongoing prospective, multicentre (conducted within the Central and Eastern European Gynaecologic Oncology Group (CEEGOG)) trial on symptomatic MA drainage with a patient-controlled central vascular catheter (CVC) inserted into the abdominal cavity. CVC (14-Ga) was inserted into the abdominal cavity of patients with symptomatic MA, and drainage was controlled by patients at home. The rate and quality of complications were classified according to Common Terminology Criteria for Adverse Events Version 5.0. QOL was evaluated before and 10–14 days after/during drainage with standardized QLQ-C15-PAL, SGA, and FACIT-TS-G questionnaires. Wilcoxon and Chi-squared tests were used. Among 113 recruited patients (2015–2022), seven patients experienced complications (6.2%), and there was one patient with a serious adverse event (death on the 9th day after catheter insertion, classified as not related to the intervention). Adverse events included local infection (n = 2) (resolved after oral antibiotics), catheter obstruction (n = 2), catheter self-removal (n = 2) (re-insertion performed), and nausea (n = 1). When comparing the assessment before and after/during drainage, we found the significantly better global QOL (mean 31.8 vs. 47.8, p < 0.001), improvement in physical (52.6 vs. 64.4, p < 0.001) and emotional functioning (50.7 vs. 65.4, p < 0.001); symptoms were significantly less intense: fatigue (66.7 vs. 50.9, p < 0.001), nausea and vomiting (37.8 vs. 21.4, p < 0.001), pain (53.9 vs. 34.1, p < 0.001), dyspnoea (48.5 vs. 22.3, p < 0.001), insomnia (49.1 vs. 34.3, p < 0.001), appetite loss (56.3 vs. 40.3, p < 0.001), and constipation (31.0 vs. 25.2, p = 0.007), and more patients had no pain on eating (71.3% vs. 82.9%, p = 0.04). Most patients (78%) were satisfied, 83% would recommend the procedure to others, and 90% would choose intervention again. The interim analysis provided data on the safety and improvement of patients’ QOL after MA drainage via patient-controlled CVC inserted into the abdominal cavity, thus justifying the continuation of recruitment for the main trial without changes in the protocol.

Proteomics is nowadays increasingly becoming part of the routine clinical practice of diagnostic laboratories, especially due to the advent of advanced mass spectrometry techniques. This review focuses on the application of proteomic analysis in the identification of pathological conditions in a hospital setting, with a particular focus on the analysis of protein biomarkers. In particular, the main purpose of the review is to highlight the challenges associated with the identification of specific disease‐causing proteins, given their complex nature and the variety of posttranslational modifications (PTMs) they can undergo. PTMs, such as phosphorylation and glycosylation, play critical roles in protein function but can also lead to diseases if dysregulated. Proteomics plays an important role especially in various medical fields ranging from cardiology, internal medicine to hemato‐oncology emphasizing the interdisciplinary nature of this field. Traditional methods such as electrophoretic or immunochemical methods have been mainstay in protein detection; however, these techniques are limited in terms of specificity and sensitivity. Examples include the diagnosis of multiple myeloma and the detection of its specific protein or amyloidosis, which relies heavily on these conventional methods, which sometimes lead to false positives or inadequate disease monitoring. Mass spectrometry in this respect emerges as a superior alternative, providing high sensitivity and specificity in the detection and quantification of specific protein sequences. This technique is particularly beneficial for monitoring minimal residual disease (MRD) in the diagnosis of multiple myeloma where traditional methods fall short. Furthermore mass spectrometry can provide precise typing of amyloid proteins, which is crucial for the appropriate treatment of amyloidosis. This review summarizes the opportunities for proteomic determination using mass spectrometry between 2012 and 2024, highlighting the transformative potential of mass spectrometry in clinical proteomics and encouraging its wider use in diagnostic laboratories.

Psoriasis is a chronic systemic autoimmune disease associated with an elevated risk of developing cardiovascular disease. In patients with psoriasis, arterial hypertension treatment requires careful selection of antihypertensive drugs, as some drugs may worsen the skin manifestations of psoriasis. In this review, we summarize the available evidence regarding the risks and benefits of each group of antihypertensive drugs. We also suggest a scheme for optimizing antihypertensive treatment in patients with psoriasis, with emphasis on achieving effective control of blood pressure and cardiovascular disease, while minimizing the worsening of cutaneous manifestations. Angiotensin receptor blockers appear to be the most appropriate treatment for hypertensive patients with psoriasis, with the potential addition of calcium channel blockers if blood pressure is not adequately controlled. Alternatives are angiotensin-converting enzyme inhibitors and/or mineralocorticoid receptor antagonists. Diuretics and beta blockers are associated with greater risk of worsening of psoriatic lesions.

Multidimensional chromatography coupled to tandem mass spectrometry (MS/MS), including simple sample preparation with protein precipitation, anion conversion with ammonium hydroxide, and solid-phase extraction using mixed-mode anion exchange in a 96-well plate format, has been validated for rapid simultaneous analysis of human insulin and its six analogs (lispro, glulisine, glargine, degludec, detemir, and aspart) in human plasma. This method is critical for clinical diagnostics, forensic investigations, and anti-doping efforts due to the widespread use of these substances. In the present study, improved chromatographic resolution was achieved using a first-dimension trap-and-elute configuration with an XBridge C18 (2.1 × 20 mm, 3.5 µm) trap column combined with second dimension separation on a Cortecs Ultra-High-Performance Liquid Chromatography (UHPLC) C18+ (2.1 × 100 mm, 1.6 µm) analytical column implemented within a two-dimensional-LC-MS/MS system. The total chromatographic run time was 11 min. This setup increases both the resolution and sensitivity of the method. A mobile phase consisting of 0.8% formic acid (FA) in water and 0.7% FA in acetonitrile was used for gradient elution. Bovine insulin was used as the internal standard. MS detection was performed in positive electrospray ionization mode, and the ion suppression due to matrix effects was evaluated. Validation criteria included linearity, precision, accuracy, recovery, lower limit of quantitation, matrix effect, and stability tests with and without protease inhibitor cocktail under different conditions (short-term stability, long-term stability, and freeze-thaw stability). The concentration range for all insulins was 50–15 000 pg/mL, with limits of quantification below the therapeutic reference range for all analytes. Intra-run precision ranged from 1.1% to 5.7%, inter-run precision from 0.7% to 5.9%, and overall recovery from 96.9% to 114.3%. The validated method has been implemented successfully by the Department of Forensic Medicine at our hospital for the investigation of unexplained deaths.

Massive bleeding causes approximately 50% of deaths in patients with major trauma. Most patients die within 6 h of injury, which is preventable in at least 10% of cases. For these patients, early activation of the massive transfusion protocol (MTP) is a critical survival factor. With severe trauma, high-mobility group box 1 (HMGB-1, i.e., amphoterin) is released into the blood, and its levels correlate with the development of a systemic inflammatory response, traumatic coagulopathy, and fibrinolysis. Previous work has shown that higher levels of HMGB-1 are associated with a higher use of red blood cell transfusions. We conducted a retrospective analysis of previous prospective single-center study to assess the value of admission HMGB-1 levels in predicting activation of MTP in the emergency department. From July 11, 2019, to April 23, 2022, a total of 104 consecutive adult patients with severe trauma (injury severity score > 16) were enrolled. A blood sample was taken at admission, and HMGB-1 was measured. MTP activation in the emergency department was recorded in the study documentation. The total amount of blood products and fibrinogen administered to patients within 6 h of admission was monitored. Among those patients with massive bleeding requiring MTP activation, we found significantly higher levels of HMGB-1 compared to patients without MTP activation (median [interquartile range]: 84.3 µg/L [34.2–145.9] vs. 21.1 µg/L [15.7–30.4]; p < 0.001). HMGB-1 level showed good performance in predicting MTP activation, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.75–0.93) and a cut-off value of 30.55 µg/L. HMGB-1 levels correlated significantly with the number of red blood cell units (rs [95% CI] 0.46 [0.28–0.61]; p < 0.001), units of fresh frozen plasma (rs 0.46 [0.27–0.61]; p < 0.001), platelets (rs 0.48 [0.30–0.62]; p < 0.001), and fibrinogen (rs 0.48 [0.32–0.62]; p < 0.001) administered in the first 6 h after hospital admission. Admission HMGB-1 levels reliably predict severe bleeding requiring MTP activation in the emergency department and correlate with the amount of blood products and fibrinogen administered during the first 6 h of hemorrhagic shock resuscitation. Trial registration: NCT03986736. Registration date: June 4, 2019.

Aims The concept of prehabilitation, defined as interventions aimed at enhancing a patient's functional capacity prior to an impending physiological stressor, may contribute to reduced postoperative morbidity and mortality. The study's goal is to verify or refute the feasibility of a prehabilitation programme for two diagnostic patient groups during neoadjuvant chemo(radio)therapy, which is prescribed before the scheduled surgical procedure. This is a single group study design, with all patients enrolled receiving the intervention. Methods This is an interventional feasibility study of a prehabilitation programme in the form of physical training conducted at home. The training consists of progressively dosed walking and strength exercises for selected muscle groups. Data will be monitored telemetrically and also through telephone contact with participants. Primary outcomes include: the percentage of patients interested in participating in the study out of all patients indicated for neoadjuvant therapy at University Hospital Ostrava during the observed period, the percentage of patients who complete the prehabilitation programme until the date of surgery and individual patient compliance. Secondary outcomes include physical fitness parameters obtained from cardiopulmonary exercise testing, grip strength measured by a dynamometer, changes in body composition, EORTC QLQ-C30 quality of life questionnaire, and a questionnaire on the subjective perception of the exercise programme. Both primary and secondary outcomes will be compared between study arms (two diagnostic groups). The study is registered at ClinicalTrials.gov , ID: NCT05646043. Conclusion The results of this study can serve as a foundation for larger, multicentre, controlled studies in the future.

Background and Objectives: The aim of this study was to determine the effect of immersive virtual reality used as a short-term multifaceted activity with a focus on motor and cognitive function in patients with Parkinson’s Disease. The sub-objective focused on quality of life in the study group of patients. Materials and Methods: Nineteen patients (64.2 ± 12.8 years) were included in this study. Inclusion criteria for this study: adult patients in Hoehn and Yahr’s stage 1–3, cooperative, with stable health status, independent and mobile. IVR therapy was performed twice a week for 20 min for one month. Input and output measurements were taken within 14 days of starting or ending therapy. The 10 Meter Walk test was used to examine and assess both comfortable and fast walking, and the Timed Up and Go (TUG) + s dual task was applied to quickly assess the highest possible level of functional mobility. The Berg Balance Scale test (BBS) was used to assess balance with a 14-item balance scale containing specific movement tasks. The standardized Parkinson’s Disease Questionnaire (PDQ-39) was used to assess quality of life. Data were processed in the PAST program using a nonparametric paired Wilcoxon test. The significance level was set at α = 0.05. The value of the r score was used to evaluate the effect size. Results: A significant reduction in the time in the fast walk 10MWT (p = 0.006; r = 0.63) and TUG (p < 0.001; r = 0.80) parameter were found after therapy. Significant improvement in the BBS score was found after applied therapy (p = 0.016; r = 0.55). In the PDQ-39 questionnaire, significant improvements were found in the study group after therapy in the domains of mobility (p = 0.027; r = 0.51) and emotional well-being (p = 0.011; r = 0.58). Conclusions: The results of this study indicate a positive effect of virtual reality therapy on balance and gait, which is also good in terms of reducing the risk of falls in the study group. Therapy also promoted quality of life in the study group.

The Rare Gynecologic Sarcoma (REGYS) study is a project involving 23 institutions from 10 countries focusing on myxoid leiomyosarcoma and non-smooth muscle uterine sarcomas. Here, we present the main results of the study, including the comparison between the original and final diagnosis, the frequency and type of molecular aberrations, and the clinicopathological outcomes. A total of 379 cases were included, with available results for NGS RNA in 338/379 cases and NGS DNA in 335/379 cases. According to the original diagnoses, the study included 204 cases of low-grade endometrial stromal sarcoma (LG-ESS), 75 cases of high-grade endometrial stromal sarcoma (HG-ESS), 74 cases of undifferentiated uterine sarcoma (UUS), 17 cases of myxoid leiomyosarcoma, and 9 cases of unclassifiable sarcoma. The results of our second reading showed that 29% (110/379) of all the tumors had been originally misdiagnosed. After the re-classification, the final diagnoses were 147 cases of LG-ESS, 69 cases of HG-ESS, 58 cases of UUS, 3 cases of LG-ESS with high-grade transformation, 7 cases of PEComa, 9 cases of UTROSCT, 8 cases of tumors with a KAT6B/A::KANSL1 fusion, two cases of tumors with an NTRK fusion, 29 cases of undifferentiated carcinoma, and 47 tumors with smooth muscle differentiation. The molecular testing showed that LG-ESS harbor a recurrent fusion in 75.9% and HG-ESS in 43.7% of cases. The results of our study emphasize the diagnostic, prognostic, and predictive significance of molecular testing in mesenchymal uterine tumors.

Background and Objective: Metabolomic interaction networks provide critical insights into the dynamic relationships between metabolites and their regulatory mechanisms. This study introduces MInfer, a novel computational framework that integrates outputs from MetaboAnalyst, a widely used metabolomic analysis tool, with Jacobian analysis to enhance the derivation and interpretation of these networks. Methods: MInfer combines the comprehensive data processing capabilities of MetaboAnalyst with the mathematical modeling power of Jacobian analysis. This framework was applied to various metabolomic datasets, employing advanced statistical tests to construct interaction networks and identify key metabolic pathways. Results: The application of MInfer revealed significant metabolic pathways and potential regulatory mechanisms across multiple datasets. The framework demonstrated high precision, sensitivity, and specificity in identifying interactions, enabling robust network interpretations. Conclusions: MInfer enhances the interpretation of metabolomic data by providing detailed interaction networks and uncovering key regulatory insights. This tool holds significant potential for advancing the study of complex biological systems.

Introduction The indication for endoscopic third ventriculostomy is often contested in children younger than 1 year. This study aims to establish the benefits of this modality in children with idiopathic congenital aqueductal stenosis. Methods Retrospective analysis was performed on patients <1 year old with idiopathic congenital aqueductal stenosis undergoing endoscopic third ventriculostomy between 2004 and 2020. Preoperative cerebral imaging was performed in all cases. Endoscopic third ventriculostomy efficacy and overall patient outcome were evaluated over the entirety of the monitoring period averaging 146 months (range, 34-218 months). Outcome was assessed by modified Rankin Scale score. Treatment success was assessed in relation to the Endoscopic Third Ventriculostomy Success Score (ETVSS), patient age, and perioperative findings of membranes in the interpeduncular cistern. Results The study comprised 14 children aged from 6 to 280 days, mean age 16 weeks, with 11 patients aged <6 months. The characteristic presentation was progressive macrocephaly, with the setting sun sign in 2 cases. The overall Endoscopic Third Ventriculostomy Success Score was 52.1%, whereas endoscopic third ventriculostomy was successful in 12 patients (85.7%) in the first year postoperation and in 11 cases (78.6%) in the long term. Endoscopic third ventriculostomy failure was not related to patient age ( P > .99) or perioperative findings of interpeduncular cistern membranes ( P = .51). Patient outcome averaged modified Rankin Scale score 1. Most children were without or with minimal disability. Conclusions We consider endoscopic third ventriculostomy a safe and effective modality for the initial treatment of patients aged <1 year presenting with congenital aqueductal stenosis–based hydrocephalus.

The histological grade is crucial for therapeutic management, and its reliable preoperative detection can significantly influence treatment approach. Lacking established risk factors, this study identifies preoperative predictors of high-grade skull base meningiomas and discusses the implications of non-invasive detection. A multicentric study was conducted on 552 patients with skull base meningiomas who underwent primary surgical resection between 2014 and 2019. Data were gathered from clinical, surgical and pathology records and radiological diagnostics. The predictive factors of higher WHO grade were analysed in univariate analysis and multivariate stepwise selection logistic regression analysis. Histological analysis revealed 511 grade 1 (92.6%) and 41 grade 2 (7.4%) meningiomas. A prognostic model predicting the probability of WHO grade 2 skull base meningioma (AUC 0.79; SE 0.04; 95% Wald Confidence Limits (0.71; 0.86)) based on meningioma diameter, presence of an arachnoid plane and cranial nerve palsy was built. Accurate preoperative detection of WHO grade in skull base meningiomas is essential for effective treatment planning. Our logistic regression model, based on diameter, cranial nerve palsy, and arachnoid plane, is tailored for detecting WHO grade 2 skull base meningiomas, even in outpatient settings.

Data from 5173 patients hospitalized for COVID-19 at the University Hospital of Ostrava (UHO) between March 2020 and December 2021 were analysed in this retrospective study. The research aimed to find out whether the comorbidities being present increased the need for acute rehabilitation during COVID-19 hospitalization. Data were examined using descriptive statistics, Spearman's correlation coefficient, and binomial logistic regression. Among the total patient cohort (n = 5173), 27% required rehabilitation (RHB). The average age of patients was 64.9 ± 16.9 years, with rehabilitation durations ranging from 1 to 102 days. Of the rehabilitated patients, 92% (n = 1302) had hospital stays from 1 to 15 days, while 8% (n = 114) stayed more than 15 days. Patients had a median of 4 diagnoses each, with approximately one-fifth having more than six diagnoses. A weak but statistically significant positive association was observed for the length of rehabilitation and the number of diagnoses (Spearman’s correlation coefficient rs = 0.24). Adjusted statistical analysis revealed that patients with concomitant neurological conditions (G62, G81 according to ICD-10) (OR = 8.4; 95% CI 4.82–14.67) and certain respiratory diseases had the highest likelihood of requiring rehabilitation during their COVID-19 hospitalization. Additionally, patients with obesity were approximately 1.4 times more likely to need RHB than non-obese patients. The need for rehabilitation increased with the number of comorbidities, with the greatest need connected with neurological diagnosis. In light of these findings, more effective strategies for diagnosis, treatment and prevention can be developed for future epidemics or pandemics. It is imperative to reinforce health recommendations. The analysis of data enables the formulation of evidence-based public health guidelines that can serve as the foundation for a prompt and effective response in the event of another pandemic.