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Deep Brain Stimulation can improve tremor, bradykinesia, rigidity, and axial symptoms in patients with Parkinson’s disease. Potentially, improving each symptom may require stimulation of different white matter tracts. Here, we study a large cohort of patients (N = 237 from five centers) to identify tracts associated with improvements in each of the four symptom domains. Tremor improvements were associated with stimulation of tracts connected to primary motor cortex and cerebellum. In contrast, axial symptoms are associated with stimulation of tracts connected to the supplementary motor cortex and brainstem. Bradykinesia and rigidity improvements are associated with the stimulation of tracts connected to the supplementary motor and premotor cortices, respectively. We introduce an algorithm that uses these symptom-response tracts to suggest optimal stimulation parameters for DBS based on individual patient’s symptom profiles. Application of the algorithm illustrates that our symptom-tract library may bear potential in personalizing stimulation treatment based on the symptoms that are most burdensome in an individual patient. Different motor symptoms respond variably to deep brain stimulation in Parkinson’s Disease. Rajamani et al. suggest that this variability may be due to tremor, bradykinesia, rigidity, and axial symptoms being associated with a gradient of brain circuits.

Patients undergoing kidney transplant are at risk of severe COVID-19. Our single-center retrospective analysis evaluated the outcomes of kidney transplant outpatients with COVID-19 who were managed with reduced immunosuppression and treatment with molnupiravir. Between January 2022 and May 2023, we included 93 patients (62 men, average age 56 years), serum creatinine 127 (101–153) µmol/L. Molnupiravir was administered, and immunosuppressive therapy was reduced immediately following the confirmation of SARS-CoV-2 infection by PCR, which was 2 (1–3) days after the onset of symptoms. Only three (3.2%) patients required hospitalization, and one patient died. Acute kidney injury was observed in two patients. During the follow-up period of 19 (15–22) months, there was no significant increase in proteinuria, no acute or new chronic graft rejection, and kidney graft function remained stable; serum creatinine was 124 (106–159) µmol/L post-COVID-19 infection and 128 (101–161) µmol/L at the end of the follow-up period. Our results demonstrate that early initiation of molnupiravir treatment combined with a temporary reduction in immunosuppressive therapy results in favorable clinical outcomes in patients with COVID-19, with preservation of good graft function and no episodes of graft rejection.

An expert discussion about the nature of identity in social work has been led in the Czech Republic for more than a quarter century. This debate did not bring a definite shift in the understanding of what social work is, nor did it bring a shared stance on what its domain should be (Chytil, 2007; Navrátil Navrátilová, 2008; Matulayová Musil, 2013; Punová Navrátilová, 2014). However, if there is any consensus on the identity of social work, it refers to the fact that social work is a socially constructed field (Navrátil, 1998, 2013a) and therefore also multiparadigmatic or discursively open. If it is difficult or impossible to capture sectoral identity with a clear and final definition, sectoral identity can be seen in a pluralistic way through discourses. This paper is built on the premise that one of the most important factors influencing a sectoral understanding of sectoral identity is university education, which is one of the key social institutions that influence or even shape social discursive space (Etzkowitz Dzisah, 2012). In the paper we present the most influential contemporary discourses, which are applied in the education of social workers, and answer the question: What assumptions about the performance of social work and more generally the concept of sectoral identity are implied by the selected discourses of education in social work? Particular among these discourses is a socio-pedagogical perspective we compare these other discourses with and show what values are crucial for each of the different discourses and how they can enrich social work as a discipline. We proceed from the extensive overview of Czech, Slovak and English-language scientific literature, published in regard to the problem o educating social workers in the past twenty years.

The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No. 296/2008 Coll.). The authors present an organizational model based on cooperation between the majority of Czech Transplant Centers with a tissue establishment licensed by the national competent authority. In various points, we are addressing individual aspects of experimental and clinical studies which affect clinical practice. Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013. The growing number of centers participating in this programme led to a growing number of patients who underwent transplantation of vascular allografts. In 2015 the numbers of transplanted fresh versus cryopreserved allografts in the Czech Republic were almost equal. Cooperation of the participating centers in the Czech Republic with the licensed Tissue Establishment made it possible to achieve a full compliance with the European Union Directives, and harmonized national legal norms and assured a high quality of cryopreserved vascular allografts.

Introduction Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to end-stage renal disease. In this study, we examine the indications, procedures, and outcomes of native nephrectomy (NN) in ADPKD patients at our transplant center. Drawing on 25 years of clinical practice, we aim to provide insights into the surgical management of ADPKD, focusing on the specific factors influencing NN. Materials and methods A retrospective study was conducted involving ADPKD patients who underwent KT and NN between 1999 and 2023. Collected data encompassed demographics and surgery parameters, such as duration, hospital stay length, blood loss, and complications. Patients were classified based on the urgency (acute/planned) of the NN and its type (unilateral/bilateral), followed by an analysis of the outcomes per group. Results Out of 152 patients post-KT for ADPKD, 89 (58.6%) underwent NN. The procedures were predominantly unilateral (71; 64%), with bilateral NN accounting for 40 (36%) cases. NN timing relative to KT was 31 (27.9%) pretransplant, 9 (8.1%) concomitant, 51 (45.9%) posttransplant, and 10 (9%) patients undergoing the sandwich technique. Acute NN were performed in 42 cases, while 69 were planned. Acute NNs were associated with longer surgeries, greater blood loss, and a higher incidence of perioperative complications compared to planned NNs. Specifically, unilateral acute NN had a 23.8% complication rate compared to 2.9% in planned cases; bilateral acute NN showed a 28.6% complication rate versus 4.3% in planned cases. Conclusion This investigation accentuates the significance of planning and selection in NN for ADPKD, factoring in the heightened risk of complications. Acute NN are linked to worse outcomes, including higher rates of complications. The data emphasize the necessity of tailored surgical approaches based on individual patient circumstances.

Background Tunica albuginea plication is a common surgical treatment for Peyronie’s disease that aims to correct penile curvature and improve sexual function. The goal of this study was to evaluate patient-reported outcomes, complications, and predictors of success following plication surgery in a large cohort of patients. Results This retrospective, bicenter study included 80 patients with a mean age of 48.6 years and a mean preoperative curvature of 49.2°. Postoperative satisfaction was reported by 67% of patients. Erectile dysfunction developed in 16%, and 13% experienced complications. Among those with preoperative penile pain, 42% continued to report pain postoperatively. Reoperation was required in 12% of cases. Statistically significant associations were observed between greater preoperative curvature and higher patient satisfaction, longer follow-up duration and erectile dysfunction, and longer surgery duration and persistent pain. Patients with complex curvature patterns had a higher risk of reoperation. Conclusions Plication surgery is an effective and safe option for treating penile curvature in Peyronie’s disease, particularly in patients with more severe deformities. Greater curvature severity predicted higher satisfaction, while longer surgeries and follow-up were associated with increased pain and erectile dysfunction. These findings can help guide patient counseling and surgical planning.

Background Renal cell carcinoma (RCC) is a prevalent kidney malignancy known for its aggressive nature and potential to extend into the renal vein or inferior vena cava (IVC), affecting patient prognosis and treatment strategies. Objective To assess the long-term outcomes and effectiveness of radical nephrectomy with IVC thrombectomy in patients with RCC presenting with level I-IV IVC thrombus. Methods A retrospective analysis was conducted on 164 adult patients treated for RCC with IVC thrombectomy at a tertiary care center from January 2004 to December 2023. Data including demographics, clinical characteristics, tumor specifics, surgical details, complications, and survival rates were meticulously reviewed. Results Among the patients, the mean age was 63.7 years, predominantly male (69.5%). The histological profile showed a majority of clear cell carcinoma (95.7%), with most tumors located on the right side (71.3%). Thrombus levels were distributed across I-IV, with 41 (25%) patients presenting with level I, 33 (20.1%) with level II, 55 (33.5%) with level III, and 35 (21.4%) with level IV thrombi. The mean operation time and blood loss increased with thrombus level. Perioperative complications were recorded in 57.3% of patients, and over half of the patients experienced disease recurrence (54.9%). The overall 5-year survival rate stood at 42.1%, with notably better survival in patients with level I thrombi. Conclusion Radical nephrectomy with IVC thrombectomy provides a potential for long-term control in patients with RCC and IVC thrombus, although it is associated with significant morbidity. Multidisciplinary care and expert surgical intervention are crucial for improving patient outcomes. The variability in survival rates across thrombus levels underscores the need for individualized treatment approaches.

Objectives: This review answers the following questions: (1) What is the potential role of social work in prevention, intervention, and postvention in dealing with suicide? (2) What factors limit social work involvement? Methods: A sample of 84 peer-reviewed articles selected via PubMed, Scopus, and Google Scholar were analysed using content analysis. Findings: Results indicate that the role of social work in suicide prevention, intervention and postvention has been primarily established as a clinical or mental health social worker's task. However, generalist social workers can also effectively use their training in dealing with suicide at individual, family, organisational, and community levels. The study revealed that social work intervention in suicide prevention is reduced by several factors, including limited social work research interests in suicide, lack of education and training of social workers in dealing with people with suicidal ideation, and professional anxiety caused by clients' suicides.Conclusion: Incorporating suicide content into social work education, increasing social workers' training, and utilising generalist social workers' potential are required to increase social work contribution.

Background This systematic review discusses a clinical physiology aspect of chloride in fluid therapy. Crystalloid solutions are one of the most widely used remedies. While generally used in medicine for almost 190 years, studies focused largely on their safety have only been published since the new millennium. The most widely used solution, normal saline, is most often referred to in this context. Its excessive administration results in hyperchloremic metabolic acidosis with other consequences, including higher mortality rates. Methods Original papers and review articles eligible for developing the present paper were identified by searching online in the electronic MEDLINE database. The keywords searched for included hyperchloremia, hypochloremia, and compound words containing the word “chloride,” infusion therapy, metabolic acidosis, renal failure, and review. Results A total of 21,758 papers published before 31 May 2020 were identified; of this number, 630 duplicates were removed from the list. Upon excluding articles based on their title or abstract, 1850 papers were screened, of which 63 full-text articles were assessed. Conclusions According to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function.