University Hospital Plzen

Migratory birds face numerous challenges as they travel to and from their wintering grounds. Their ability to overcome these obstacles depends on their physical fitness, energy reserves and migration strategy. During migration, birds often need flight interruptions in vegetated areas which play a crucial role for migrants heading to wintering quarters or flying back to breeding areas. For the migratory raptor, the Western Marsh Harrier Circus aeruginosus a particularly difficult challenge is crossing the Sahara Desert. In this region, the birds encounter areas with lack of vegetation and harsh atmospheric conditions. To understand their behaviour in such an unfavourable environment, we studied the migratory patterns of Marsh Harriers in the Sahara Desert using GPS/GSM telemetry from 2019 to 2023. We examined flight interruptions within an hourly resolution and unique stop sites in hyper-arid areas of the Sahara Desert and enhanced the dataset with Normalised Difference Vegetation Index (NDVI), land cover data, U (velocity of the east-west) and V (velocity of the north-south) wind components and sunrise and sunset times. We explored the timing of the daytime flight interruptions used by Marsh Harriers and described the selection of sites with emphasis on the NDVI. Marsh Harriers preferred areas with higher NDVI and increased distance between unique stop sites. We also found increased density of flight interruptions during late afternoon and tendency for flight interruptions in the vicinity of consecutive night roost. Flight interruptions were also affected by wind conditions. Our study, made possible by advanced GPS/GSM technology and remote sensing data, provides new insights into the use of unique stop sites by Marsh Harriers during migration over the Sahara Desert. It underlines the importance of scarce vegetation during the Sahara crossing for the Marsh Harrier and helps to explain the selection of areas within a harsh environment used for breaks of a short duration. Our findings open the door for further investigation of Marsh Harrier behaviour during migration through harsh environments.

One of the surgical treatment options for advanced ankle joint destruction with various etiologies is the total joint replacement. Its significant upside is the preservation of range of motion of the ankle joint and less stress on forefoot joints compared to ankle arthrodesis. Since 2022, we have been using the Zimmer Trabecular Metal Total Ankle inserted via a lateral transfibular approach. This study aims to evaluate the initial outcomes and experience with this implant. Between 2022 and 2024, 65 total ankle replacements were performed in 63 patients using the lateral transfibular approach. Long oblique osteotomy is newly performed in the frontal plane, replacing the original type of osteotomy in the sagittal plane. After releasing and removing the distal fragment of the fibula distally and dorsally, the lower limb and ankle are placed in an alignment frame, which is fixed with Steinmann pins to the calcaneus, anterior border of the tibia, and the talus bone. The centre of rotation of the ankle is identified using the side bars anchored in the frame. Using the burs, guided by Cutting Guides that are locked to the frame, the talus and distal tibia are removed. After testing, rail holes are drilled in the resected surfaces for the original implants. After releasing the tourniquet, the original components are inserted and osteosynthesis of the fibula is performed. During the study, the previously performed fibula osteosynthesis with LCP was replaced by lag screws. Postoperatively, the ankle is supported with a brace for the period of 5 weeks, after which the patient is permitted to fully weight-bear. A total of 63 patients (32 women and 31 men) were followed, in whom 65 total ankle replacements were performed. The mean age of the patient was 56 years (age range 30 to 80 years). The mean follow-up period was 14.6 ± 9.3 months (3 to 38 months). The most frequent indication was post-traumatic ankle arthritis, namely in 46 cases (70.8%). Furthermore, there were 5 patients (7.7%) with post-traumatic ankle ankylosis, 9 patients (13.8%) with primary osteoarthritis, and in 5 patients (7.7%) the indication was the damage caused by rheumatoid arthritis. Deep bacterial infection of the prosthesis requiring revision was reported in 3 cases (4.6%). Superficial infection of the surgical wound was seen in 4 other cases (6.2%), which did not require hospitalization. Plate osteosynthesis of the fibula was removed in 7 cases (13.8%), 5 times due to infection and 2 times due to soft tissue irritation. One case of asymptomatic non-union of fibula was observed. The benefit of total ankle replacement is the preservation of motion of the operated joint, whereas the complication rate is twice as high as in arthrodesis. Contraindications for ankle replacement include significant varus and valgus deformities of the ankle, ankle instability, necrosis of the talus, severe diabetes mellitus, and severe limb ischemia. The advantage of the transfibular approach is the ability to partly correct deformities of the ankle joint and the position of varus or valgus. It provides a better view of the dorsal structures of the ankle and allows accurate identification of the centre of rotation. Another advantage is the low thickness of the components, requiring minimal bone resection. The main disadvantage is the longer operative time and longer learning curve. Other disadvantages include the complications associated with osteosynthesis and fibula healing, such as non-union or soft tissue irritation by plate. The incidence of superficial and deep infection is also slightly higher compared to the anterior approach. The Zimmer Trabecular Metal Total Ankle system is one of the treatment options for ankle joint destruction provided it is correctly indicated. However, the surgical procedure is a challenge and requires an experienced surgeon. When the indication is correct, the system brings very good short-term outcomes. Nonetheless, longer follow-up period is necessary since the incidence of complications will certainly increase over time.

Abstract Background Comparative data on risankizumab (RISA) and upadacitinib (UPA) in Crohn’s disease (CD) are limited. In this preliminary analysis, we assessed treatment persistence with these agents and explored whether the choice should be modified according to disease location. Methods Data from the Czech National Prospective Registry of Biological and Innovative Therapies for Inflammatory Bowel Disease (CREdIT) were analysed to evaluate treatment persistence in adult and paediatric patients with CD who began treatment with RISA or UPA, with a minimum follow-up period of three months. Patients with missing outcomes or dual advanced therapy were excluded. Inverse-probability-of-treatment weighting (IPTW) based on a propensity score including demographic, disease activity and treatment history variables was applied to reduce confounding factors. Treatment persistence was analysed using Kaplan–Meier curves and Cox proportional hazards models, clustered by patient. We evaluated whether disease location (ileal vs non-ileal) altered treatment persistence by using group-specific survival analyses. Results A total of 474 treatment observations were identified in patients receiving RISA or UPA. Following the application of exclusion criteria, the analysis included 370 observations from 323 patients, of which 157 (42%) were on RISA and 213 (58%) were on UPA. Of these, 11 (7%) were paediatric patients in the RISA group and 22 (10%) in the UPA group. The median number of actual lines of advanced therapy was four in both groups, with 38% of RISA observations and 39% of UPA observations representing ≥ 5th treatment line. Groups differed only in age at treatment start (median 38 vs 37 years). Ileal disease only was present in 23 (15%) RISA patients and 28 (13%) UPA patients. Unadjusted data (Figure 1) demonstrated higher persistence of RISA vs. UPA treatment. After balancing the cohort using IPTW, all standardised mean differences between groups were below 0.1. Compared with RISA, UPA was associated with a higher risk of treatment discontinuation (hazard ratio: 2.83; 95% confidence interval: 1.50–6.34). Interaction analysis by disease location was not feasible because no RISA failures occurred in the ileal subgroup. Therefore, only descriptive stratified curves are shown in Figure 2. Conclusion In this preliminary analysis of refractory CD, treatment persistence was greater with RISA than with UPA. These real-world data suggest that RISA may be a more durable treatment option, particularly for patients with ileal CD. However, confirmation in larger patient groups is required. Conflict of interest: Dr. Hradsky, Ondrej: Lectures/congress fees/consultancy from MSD, AbbVie, Takeda, Sandoz, Nutricia, Ferring, Pfizer, and Lilly. Duricova, Dana: Lectures/congress fees/consultancy (outside the scope of the submitted work) from Johnson & Johnson, Takeda, AbbVie, Pfizer, Ferring, Eli Lilly, and Celltrion. Lukás, Milan: Research Support / Clinical trials: Biogen, Takeda, Janssen Consultant / Speaker : Abbvie, Ferring, Takeda, Janssen Speakers Bureau / Advisory Board Member: Pfizer, Roche, Egis, Celltrion, Takeda, Janssen, Eli Lilly Employee: ISCARE a.s./1stMedical Faculty, Charles University, Prague Nedbalova, Lenka: No conflict of interest Bouchner, Luděk: No conflict of interest Pipek, Barbora: Lectures/congress fees/consultancy (outside the scope of the submitted work) from Johnson & Johnson, Takeda, AbbVie, Pfizer, and Eli Lilly. Svoboda, Pavel: Lectures/congress fees/consultancy (outside the scope of the submitted work) from AbbVie, Takeda, Janssen-Cilag, Celltrion, Tillotts, Alfasigma, Sandoz, Pfizer, and Eli Lilly. Siroky, Milan: No conflict of interest Bronsky, Jiri: Lectures/congress fees/consultancy (outside the scope of the submitted work) from AbbVie, Sandoz, Danone-Nutricia, Nestlé, Sanofi, Pfizer, and Vitabalans. Bortlik, Martin: Lectures/congress fees/consultancy (outside the scope of the submitted work) from AbbVie, Takeda, Janssen-Cilag, Celltrion, Roche, AstraZeneca, Biogen, Tillotts, Ferring, Alfasigma, PRO.MED.CS, Sandoz, Bristol-Myers Squibb, Pfizer, and Swedish Orphan Biovitrum.

Patients undergoing periods of starvation or malnutrition may develop degenerative and/or atrophic changes of various organs. These findings may manifest histologically and may cause confusion when first encountered, raising a differential that includes benign and malignant tumor entities. Herein, we report 16 cases of incidentally identified degenerative changes within abdominal-site fatty tissues that caused diagnostic difficulties. The patients were 11 males and 5 females, aged from 1 day to 82 years (mean: 58years). The degenerative changes were all incidentally identified within adipose tissue of the abdominal cavity or adjacent to organs contained within the abdominal cavity in procedures done for unrelated reasons such as cancer, infection, or perforation. Cases were identified in the colon (n=6), small intestine (n=4), omentum (n=3), inguinal hernia sac (n=1), peritoneum (n=1), and retroperitoneal soft tissue (n=1). Patients had variable past medical histories with multiple comorbidities. Ten patients presented with some form of malnutrition and/or cachexia. Histologically, the lesions demonstrated lobules of atrophic-appearing fat with small signet-ring-like adipocytes that were sometimes bilobed. The nodules varied in size and were characterized in some cases by a variably myxoid stromal background, often with a prominent delicate capillary network. Immunohistochemistry was performed and was uniformly positive for S100 protein and negative for cytokeratins. The lesions were generally recognized as degenerative, but various differential diagnoses proposed at the time of sign-out included signet-ring cell carcinoma, liposarcoma, and vascular lesions, among others. Nomenclature to describe this phenomenon has been inconsistent in the literature, and thus, we suggest the term "pseudoneoplastic fat atrophy."

Abstract Motivated by the real-world problem of locating hydrogen production facilities and assessing different production technologies which differ in the flexibility of operations and costs, we study a multi-stage multi-horizon stochastic facility location problem with capacity expansion. The objective is to minimize the expected sum of investment, production and distribution costs while satisfying customer demand. The multi-horizon formulation allows to capture the effects of both strategic as well as operational uncertainty on the location decisions. Strategic uncertainty is related to uncertain future demand level, while operational uncertainty is related to uncertain future electricity prices resulting in uncertain production costs. We consider multiple production technologies that have different operational characteristics, but can be combined at a location and operated in parallel. To solve the problem, we implement and compare two solution methods: linear relaxation with a restricted MIP approach and Lagrangian relaxation with a two-step restricted MIP approach. We apply the solution approaches to instances based on the real-world problem of locating hydrogen production in Norway. The results show that both approaches can find near-optimal solutions for small instances, but the Lagrangian-based solution method can also find high-quality solutions for larger instances.

Background and Aims: Between 2004 and 2025, 72 paediatric patients were treated for aplastic anaemia (AA) in the Czech Republic, comprising 43 idiopathic and 29 hepatitis-associated (HA-AA). Among HA-AA patients, 21 were classified as AA, and 8 as refractory cytopenia of childhood (RCC). 20 of 29 HA-AA patients were male. Of 43 idiopathic AA patients, 12 received upfront HSCT and 31 IST (13 later transplanted); in HA-AA, 7 received upfront HSCT and 22 IST (9 later transplanted). Two patients required liver transplantation.

Background and ObjectivesThe number of critically ill patients with haematological conditions is increasing, yet transfusion practices in this population remain poorly defined. This study aimed to compare transfusion strategies in critically ill patients with versus without haematological conditions.Study Design and MethodsThis international, prospective observational substudy of the International Point Prevalence Study of Intensive Care Unit [ICU] Transfusion Practices (InPUT) evaluated transfusion use in ICU patients with and without haematological conditions, including benign or malignant diseases or a history of stem cell transplantation. Outcomes included use of red blood cells (RBCs), platelets, plasma, haemostatic interventions, transfusion indications and thresholds.ResultsOf 3643 ICU patients, 131 (3.6%) had a haematological condition. These patients were more likely to receive RBC (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.09–2.29) and platelet transfusions (OR 8.32, 95% CI 5.09–13.6), primarily due to low haemoglobin rather than physiological triggers. Platelet thresholds were lower (median 23 × 109/L vs. 64 × 109/L) compared to non‐haematology patients. Both platelet and plasma transfusions were more frequently administered prophylactically rather than for active bleeding. Haemostatic interventions were more often used in haematology patients, at higher doses and typically without viscoelastic testing. Transfused haematology patients had higher 28‐day mortality and longer ICU stays.ConclusionICU patients with haematological conditions receive transfusions differently, particularly regarding platelet and plasma use. These findings underscore the need for prospective studies to define optimal transfusion thresholds in this growing and vulnerable patient population, although the study's limited sample size and lack of diagnostic granularity may affect interpretation.

Succinate dehydrogenase (SDH), a critical enzyme in the citric acid cycle and respiratory electron transport chain, consists of 4 subunits: SDHA, SDHB, SDHC, and SDHD. Deficiency of a single subunit leads to the loss of SDH activity which is implicated in the development of a subset of gastrointestinal stromal tumors (GISTs): SDH-deficient GISTs. These GISTs arise almost exclusively in the stomach, have a female predilection, and primarily affect children and young adults. Their characteristic morphologic features include multinodular architecture, lymphovascular invasion, and lymph node metastasis. At the molecular level, these tumors lack KIT , PDGFRA, BRAF , or NF1 mutations, which are alternative oncogenic drivers typically observed in GIST. Recently, a sarcoma DNA methylation classifier was developed and was shown to be a valuable diagnostic tool. This study evaluated the DNA methylation classifier results for 30 SDH-deficient GISTs and discovered that methylation profiles clustered in a unique region separate from GISTs and leiomyosarcomas. Moreover, MGMT promoter methylation, a predictive biomarker of tumor cell sensitivity to alkylating agent chemotherapy, was identified in 6 primary and 5 metastatic tumors. In addition, 3 primary and 4 metastatic tumors showed gain/low-level amplification of MDM4 , which pathologically activates MDM4-p53 axis, a target of inhibitors. In summary, these findings expand the sarcoma DNA methylation classifier to include SDH-deficient GIST as a new sarcoma DNA methylation entity and identified 2 predictive biomarkers for targeted therapy: methylation of MGMT promoter and gain/low-level amplification of MDM4 .

The study aims to evaluate the mid-term functional and subjective outcomes of treatment of the mallet finger with a bone fragment using the Ishiguro extension block pinning. The hypothesis was that this technique provides reliable and high-quality outcomes with a low complication rate. The study included 54 patients aged 7-17 years who underwent surgery at our department between 2017 and 2022. The inclusion criteria were the diagnosis of the mallet finger with a Doyle type IVa and IVb bone fragment, subluxation of the distal interphalangeal joint, fracture fragment size greater than 30% of the articular surface on lateral view radiographs, and fragment dislocation greater than 2 mm. The surgeries were performed in line with the original description of the Ishiguro technique, with reduction and closed osteosynthesis of the fragment using Kirschner wires. The surgery was followed by fixation with a plaster cast for 4 weeks on average, and rehabilitation was recommended after pin removal. The outcomes were assessed using the QuickDASH questionnaire and the Crawford criteria. The mean QuickDASH score was 3.8, the median score was 0.0. A total of 59% of patients reported no difficulty or limitations, and 37% described minimal extension deficit with no subjective difficulty. Only 4% of patients experienced more severe difficulty such as significant extension deficit or pin track infection. No secondary subluxation of the distal interphalangeal joint was observed. The results of our study are in agreement with global literature, which also shows a predominantly excellent and good effect of the treatment of mallet finger by extension block pinning. Complications were associated with delayed treatment and patient noncompliance. The studies comparing different techniques show that the extension block pinning provides outcomes comparable to those achieved by other methods, or even better. The Ishiguro extension block pinning is a reliable, technically and financially undemanding technique that provides excellent outcomes in treating the mallet finger with a bone fragment. The use of this technique is also supported by the fact that it can be performed as an outpatient surgery under local anaesthesia and by its low complication rate. Nonetheless, further research is necessary to specify more accurately the indication criteria for surgical management of Doyle IVa and IVb lesions.