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In recent years, there has been an increasing interest in the clinical features and pathophysiological mechanisms of xanthomas. Most types of xanthomas develop as cholesterol-rich lesions within the skin, tendons, fasciae or periosteum. They are characterized by local accumulation of foam cells and resemble early stages of atherosclerotic plaques. The presence of xanthomas can signalise serious dyslipidemias, both common and rare, connected with an increased risk for cardiovascular, metabolic and tumorous diseases. This article provides an overview of key research findings on xanthomas, mainly from the clinical point of view.

Gastric neuroendocrine neoplasms are to heterogeneous group of gastro-entero-pancreatic tumors characterized by lower malignant potential, rising incidence, and idiosyncratic biological tumor behavior. There are three types of gastric neuroendocrine neoplasms that distinctly differ in biological and clinicopathological characteristics, as well as in different management. The article provides an overview of neuroendocrine tumor classification, their clinical characteristics, histological findings, laboratory measurement, prognosis, and therapeutic strategy. The authors present the clinical features and treatment of twenty-five patients with gastric neuroendocrine neoplasms that were diagnosed and treated by them.

The article deals with peripartum cardiomyopathy, a relatively rare disease, which is very likely in our region underdiagnosed. Increased awareness of the disease should contribute to its detection. The authors describe their own experience with the diverse clinical course of the disease. When properly diagnosed and treated it has a very good prognosis, and vice versa unrecognized or improperly treated can have fatal consequences.

This is a review of the latest information on the role of neuroactive steroids in the development of mental disorders, especially in post-partum "blues" and post-partum depression.

We describe a novel approach to preparing reference materials containing rare gene variants using the technology of gene synthesis. Especially in cases of very low frequency alleles, the technique offers the possibility of obtaining test DNA specimens with different genotypes in a short time (several weeks). The synthetically prepared specimens could serve to shorten validation cycles, calibration procedures, and to ensure regular internal and/or inter-laboratory quality control in clinical labs. Lengths of inserted fragments (several hundreds of base pairs) would be optimal for most routinely used laboratory methods (allele specific PCR, real-time PCR, hybridization methods, amplicons sequencing, etc.). One example of G20210A mutation in the FII gene and FV G1691A mutation the authors describe is the commutability and stability of synthetically prepared FII/FV reference materials with compound heterozygous genotype.

The technique of iterative CT image reconstruction is capable of a substantial reduction in both breast radiation dose and effective dose in pulmonary CT angiography. When compared to the standard filtered back projection, the lower radiation dose achieved with iterative image reconstruction was also associated with a significantly better objective and subjective image quality.

This review summarizes the latest information on the role of HIF-2α in the development of neuroendocrine tumors, especially pheochromocytoma and paraganglioma.

The authors summarize the facts and their clinical experience with omitting adjuvant radiotherapy in the early stages of breast cancer in elderly patients. Adjuvant radiotherapy is standard treatment after breast conserving surgery but in elderly patients the benefit of radiotherapy is unclear. The experience of the authors is that adjuvant radiotherapy may be safely omitted in older patients with low risk breast cancer.

The efficacy of spironolactone in different age and sex subgroups, the authors analysed the ASPIRANT trial. They found that spironolactone in a daily dose of 25 mg lead to a larger reduction in systolic BP in older patients >62 years compared to younger patients, and was equally effective in men and women.

This clinical study assessed the acute hemodynamic and ECG effects of right ventricular (RV) stimulation in different RV locations. Apical RV stimulation led to a more severe left ventricular diastolic function impairment and a larger increase in the QRS duration compared to mid-septal stimulation. Fewer acute adverse effects of RV septal stimulation make this method preferable in clinical practice.

Amniotic fluid embolism (AFE) is a rare, but very severe obstetric complication. The clinical diagnosis is one of exclusion. This paper presents six fatal cases of AFE in Slovakia from 2005-2010 and compares the incidence, possible risk factors, neonatal outcomes and the clinical course of cases in Slovakia with fatal cases of AFE in the UK during the same period.

Laser induced arteriolar constriction used in early phase of branch retinal vein occlusion (BRVO) brings significantly better visual results if compared with standard grid photocoagulation. This study proved that initial visual acuity (VA) is a strong and independent prognostic factor; initial VA ≤ 0.1 and age over 70 years are strong predictors for poor final VA. Prognostically unfavorable BRVO is defined as an occlusion with an initial VA ≤ 0.25 and these BRVOs should be treated as soon as possible.

This is a review of recent data on the most widely-spread chromosomal rearrangements in human prostate carcinomas with focus on on the diagnostic, prognostic and therapeutic implications of the TMPRSS2-ERG gene fusion.

A unique clinical study investigating the effects of preferential COX-2 in the treatment of exudative age-related macular degeneration. The results suggest a possible neuroprotective effect of COX-2

Background: Solar light generates inflammatory responses in exposed skin. These effects are generally attributed to UVB light. However, skin is expose d to a huge quantum of UVA photons as UVA is a predominant part of sunlight and the radiation used in tanning beds. We examined the effects of a single exposure to UVA and UVB wavebands on cytokine levels in skin and plasma, myeloperoxidase (MPO) activity, expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX-2) in skin. Methods: Hairless mice were irradiated with either UVA (10 or 20 J/cm²) or UVB (200 or 800 mJ/cm²). The effects were assessed after 4/24 h. Plasma cytokine levels were evaluated using a Bio-Plex cytokine assay. Cytokine, iNOS and COX-2 levels in skin were determined by Western blot. Skin MPO activity was monitored spectrophotometrically. Results: UVB induced up-regulation of interleukin-1β (IL-1β) and interleukin-6 (IL-6) and decrease in interleukin-10 (IL-10) mainly after 4 h. In contrast, UVA caused increase in levels of tumor necrosis factor-alpha (TNF-α) and IL-6 after 4 h and up-regulated IL-10 and interleukin-12 (IL-12) after 24 h. The increase in MPO activity from infiltrated leucocytes was observed only in UVB irradiated animals. iNOS was up-regulated 4 h after UVA and UVB treatment. No significant effect on COX-2 expression was detected. Conclusions: UVA and UVB light affected several inflammatory markers. For individual waveband, changes in plasma parameters did not correlate with those in skin. Thus evaluation of plasma samples cannot simply be replaced by determination in skin specimens and vice versa.

Aims: The aim was develop stable human cell line stable over-expressing transcription co-activator peroxisome proliferator-activated receptor gamma co-activator 1α (PGC-1α) with restored hepatospecific functions and increased expression of major xenobiotic metabolizing enzymes. Methods: Six clones of HepG2-PGC-1α and one control clone HepG2-pcDNA3 were isolated and analyzed for secretion of hepatospecific markers, fibrinogen, albumin and alpha1-antitrypsin. Expression levels of protein and mRNA of hepatocyte nuclear factor (HNF4α), pregnane X receptor (PXR) and aryl hydrocarbon receptor (AhR) were determined. We measured basal and ligand inducible expression of CYP1A1 and CYP3A4. Results: Stably transfected cell line HepG2-PGC-1α derived from HepG2 cells over-expressing PGC-1α displayed increased secretion of fibrinogen, but not albumin or alpha1-antitrypsin compared to parent HepG2 cells. We found increased levels of HNF4α, PXR and AhR proteins but not their mRNAs in HepG2-PGC1 cells. Basal expression of CYP3A4 protein in HepG2-PGC-1α cells was increased but rifampicin-inducible expression of CYP3A4 protein was lowered in comparison with parent HepG2 cells. Induction of CYP3A4 mRNA varied between 1.3 - 1.9 fold in individual clones. Expression of TCDD-inducible CYP1A1 protein was lower in HepG2-PGC-1α cells than in parent HepG2 cells. Induction of CYP1A1 mRNA by TCDD in HepG2-PGC-1α cells was comparable with that in parent HepG2 cells and ranged between 103 - 198 fold. Conclusion: Stable expression of PGC-1α in HepG2 cells restores several hepatospecific functions, such as secretion of fibrinogen, expression of HNF4α1 and xenoreceptors PXR and AhR. However, the expression and induction of key drug-metabolizing enzymes (CYP1A1 and CYP3A4) were not improved.

Aims: There are currently limited data about whether the effect of spironolactone in patients with resistant arterial hypertension depends on baseline blood pressure and the presence of a secondary cause of hypertension. Methods: Patients with office systolic blood pressure (BP) >140 mmHg or diastolic BP >90 mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic, were randomly assigned to receive spironolactone or a placebo for 8 weeks in a double-blind, placebo-controlled, multicentre trial (ASPIRANT). Results: Analyses were done with 55 patients treated with spironolactone. The degree of BP reduction after 8 weeks of spironolactone treatment did not differ significantly between the three tertiles of baseline systolic BP and patients with and without a secondary cause of hypertension. The reduction of office systolic, office diastolic BP and office pulse pressure was significantly lower in the highest tertile with baseline diastolic BP > 97 mmHg. Conclusions: Spironolactone treatment is effective to a similar extent both in patients with and without a secondary cause of hypertension and regardless of the baseline value of systolic BP. Less effect of spironolactone was found in patients with the highest baseline diastolic BP.

Introduction: MicroRNAs (miRNAs) are small non-coding single-stranded RNA molecules that regulate gene expression at the post-transcriptional level. In the pathogenesis of chronic lymphocytic leukemia (CLL), miR-15a and miR-16-1 play an important role. These miRNAs are located on chromosome 13 in the 13q14.3 region, which is deleted in more than 55% of CLL patients. This aberration affects expression of miRNAs. Objectives: The study aimed at performing a molecular genetic analysis of miR-15a and miR-16-1 expression in a group of 39 patients diagnosed with CLL and determining the association between the expression of the two miRNAs and types of deletions in the 13q14 region. Methods: We used fluorescence in situ hybridiziation (FISH) for determination of mono- or biallelic deletion 13q and quantitative polymerase chain reaction (Q-RT-PCR) to revealed expression miR-15a and miR-16-1 in 39 patients suffering from CLL. Results: The analysis comprised 19 patients with monoallelic 13q14 deletion, 3 patients with biallelic deletion, 9 patients with both monoallelic and biallelic deletions, and 8 patients without 13q14 deletion serving as controls. The results showed different levels of miRNA expression in individual patients. Significantly higher normalized levels of miR-15a expression were found in the control group and patients with monoallelic 13q14 expression compared with patients with biallelic deletion. There was a significantly decreased expression of both miRNAs in patients with biallelic deletion of the 13q14 region but only when deletions were present in 77% or more of cells, as detected by fluorescent in situ hybridization (FISH).

Background: Renal manifestations of rheumatic diaseases are sometimes very discrete and mild. At others, they can present the leading symptomatology of a given disease. Systemic lupus erythematosus, systemic scleroderma, renal vasculitis, rheumatoid arthritis, mixed connective tissue disease, Sjögren's syndrome and gout can all manifest in or be accompanied by renal impairment. Methods and Results: The authors reviewed the literature on renal manifestation of rheumatic diseases using the key words, lupus erythematosus, systemic autoimmune diseases, rheumatoid arthritis, vasculitis and gout. The review below is accompanied by their own histological findings. Conclusion: Diagnosis requires proper interpretation of the clinical situation, laboratory results and image analysis methods plus close interdisciplinary collaboration between nephrologist and clinical pathologist/nephropathologist.

Background: Thyroid cancer includes a broad spectrum of tumours with different prognoses. The global incidence has been increasing in recent years. Variables affecting its etiology are dietary, especially iodine intake and to a lesser extent selenium, environmental, like - ionizing radiation and, increased TSH level. These factors interplay with epigenetic and genetic changes within the cell. This review article presents thyroid cancer epidemiology, describes its main characteristics and the influence of environmental and lifestyle risk factors in the Czech Republic in comparison with other countries. Methods and Results: An epidemiological study of Czech patients with malignant thyroid carcinoma was made on the basis of the National Oncologic Registry (NOR) and Czech Statistical Office data summarized on the web portal SVOD. The data were compared with international data from the project GLOBOCAN 2008 Cancer Incidence and Mortality Worldwide. Apart from risk factors, prognostic factors with effect on patient survival were also analyzed. The survey showed that the incidence of thyroid cancer has been steadily growing in the Czech Republic. Since the beginning of the 1980s, it has increased 4 fold. It has a higher incidence than most other European countries but it is ranked with countries with an average and decreasing mortality. Obviously, the improved detection methods do not explain the growing incidence. The highest incidence is found for papillary carcinoma (PTC), now over 80% of cases. For follicular and medullar cancers, the incidence has not increased and for anaplastic carcinoma there is a slight decrease. Women over 40 years of age constitute the highest risk group. Conclusions: There are a number of reasons for these trends, such as improved diagnostic techniques using ultrasound and FNAB and more radical surgery. There are also dietary/environmental factors (iodine deficiency and to a lesser extent selenium), nitrates, polychlorinated biphenyls, increased ionizing radiation, and prolonged increase in TSH. The prognosis of patients with DTC depends on the age at the time of diagnosis. A favorable prognosis also depends on timely detection.

Background: Epigenetic changes are considered to be a frequent event during tumor development. Hypermethylation of promoter CpG islands represents an alternative mechanism for inactivation of tumor suppressor genes, DNA repair genes, cell cycle regulators and transcription factors. The aim of this study was to investigate promoter methylation of specific genes in endometrial cancer by comparison with normal endometrial tissue. Materials and Methods: We used MS-MLPA (Methylation-specific Multiplex ligation-dependent probe amplification) to compare the methylation status of 59 tissue samples of endometroid type of endometrial carcinoma with 20 control samples of non-neoplastic endometrium. Results: Using 15% cut-off for methylation, we observed significantly higher methylation in the CDH13 gene in endometrial cancer group. We observed significantly higher methylation in both WT1 and GATA5 genes in IB stage of endometroid carcinoma. We also observed significantly higher methylation in GATA5 gene in the group of poorly differentiated endometroid carcinoma. Conclusion: The findings suggest the importance of hypermethylation of CDH13, WT1 and GATA5 genes in endometrial carcinogenesis and could have implications for future diagnostic and therapeutic strategies of endometrial cancer based on epigenetic changes.

Background: The objective of the study was to report a rare case of primary neuroendocrine carcinoma of the right kidney in a 36 year old male. Methods: The patient was clinically assessed; CT and OctreoScan scintigraphy were performed and levels of 5-HIAA, vanillylmandelic acid and NSE were determined. The tumor and metastases were histologically and immunohistochemically examined. Results: The imaging methods showed a cystic tumor in the lower pole of the right kidney. Macroscopically, the entire tumor was sized 8x8x7 cm. Histologically, it was made up of ribbon-line or trabecular patterns of tumor cells. Occasional adenomatoid and cystic structures were present. The tumor cell nuclei were round or oval, with no irregularities and fine lumpy chromatin. The mitotic count was < 1 /10HPF and the proliferation marker Ki-67 was < 1 % of tumor cells. Immunohistochemically, the tumor cells were positive with antibodies against chromogranin A, synaptophysin, CD56 (focally), cytokeratins AE1-AE3 (focally), vimentin (most cells), glucagon (focally), and pancreatic polypeptide (PP; focally). Antibodies against serotonin, somatostatin, gastrin, vasoactive intestinal polypeptide (VIP) and calcitonin did not react with the tumor. The results of biochemical markers (5-HIAA, vanillylmandelic acid and NSE) did not correlate with development or treatment of the tumor. Conclusions: Primary neuroendocrine carcinoma of the kidney was diagnosed both histologically and immunohistochemically. The patient was clinically investigated using CT and OctreoScan scintigraphy. Within two years from nephrectomy, metastases were found in the right humerus and retrocaval lymph nodes. The metastatic lesions were surgically removed. Currently, the patient's condition is good, with no tumor progression detected.

Background: Diffuse large B-cell lymphoma (DLBCL) accounts for up to 40% of all non-Hodgkin's lymphomas diagnosed in the western hemisphere. Determination of the gene expression profile has confirmed the physiological heterogeneity of the disease and defined three molecular prognostic subgroups - germinal center B-cell-like (GCB), activated B-cell-like (ABC) and primary mediastinal B-cell lymphoma (PMBL) - with different gene expression and prognosis. Methods and Results: This review covers current knowledge on the most frequent recurrent cytogenetic and molecular cytogenetic aberrations in molecular DLBCL subgroups. Conclusions: Cytogenetic and molecular cytogenetic techniques used to determine nonrandom chromosomal aberrations in patients with DLBCL have revealed the incidence of frequent cytogenetic aberrations in the subgroups reported, suggesting their potential use for more accurate prognostic stratification of DLBCL, contributing to personalized selection of the most effective therapy.

Introduction: Breast conserving surgery combined with sentinel node biopsy represents currently the gold standard of treatment for early breast cancer. Although breast conserving surgery has been a widely accepted method for many years, there remain some highly controversial unresolved issues. The present analysis focused on the resection margin as one of the key factors for local control of the disease. Methods: Patient disease free survival and overall survival were collected from patients undergoing breast conserving surgery from 2004 to 2009 at the Department of Surgery Atlas hospital Zlin, Czech Republic. All patients with resection margin less then 5 mm were re-resected to achieve this clear resection margin of 5mm or more. Disease free survival (more specifically local relapse free survival, metastasis free survival and regional free survival) and overall survival were assessed. Results: The data on 330 patients were analyzed and 286/330 cases had complete follow-up. After a median follow-up of 70 months, 7 patients with isolated local relapse were identified (2.44%), 13 patients with distant metastasis without local relapse (4.54%) and 2 patients with relapse in the axilla without local relapse in the breast (0.7%). Conclusion: The final decision about the extent of resection margin remains controversial but based on the data on local control presented here it seems reasonable to increase the criteria for a clear resection margin to 5 mm.

Aims: Plasma levels of some biomarkers and markers of collagen turnover may reflect myocardial structural abnormalities associated with diastolic dysfunction. The aim of this study was to determine whether these markers could contribute to the diagnostics of heart failure with normal ejection fraction (HFNEF). Methods and Results: 91 patients with exertional dyspnea and normal left ventricular ejection fraction and 20 healthy controls underwent plasma analysis of markers of collagen turnover and other biomarkers, spirometry, and resting and exercise echocardiography. 38 patients with dyspnea had evidence of HFNEF, diagnosed at the early stage. Compared to the remaining patients, those with HFNEF had a significantly higher plasma levels of carboxy-terminal telopeptide of collagen type I (median 4.5 µg/L vs. 3.5 µg/L, P<0.05) and big endothelin (median 1.1 pmol/L vs 0.9 pmol/L, P<0.05). Univariate logistic regression analysis revealed a significant association between HFNEF and the following biomarkers: big endothelin, amino-terminal propeptide of type III procollagen (PIIINP), and matrix metalloproteinase-2 (MMP-2). However, none of these biomarkers independently contributed to the HFNEF diagnostics in a multivariate logistic regression analysis. Conclusion: Plasma levels of big endothelin, PIIINP, and MMP-2 were found to be associated with the presence of early diagnosed HFNEF. However, none of these biomarkers contributed independently to current noninvasive HFNEF diagnostics recommended by the European Society of Cardiology guidelines.

Background: Thyroid gland disturbances are the most common endocrine disorders in pregnancy. There are some particular recommendations for the investigation of women in risk groups, but no consensus guidelines for general screening exists at present in the Czech Republic. Aim: The aim of our study was to determine whether universally conducted screening of pregnant women would reveal a significant number thyropathies. Material and Methods: We examined 592 pregnant women for thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels and for autoantibodies against thyroperoxidase (antiTPO) in the 6^th - 10^th week of their pregnancy. Results: Levels of TSH, fT4 or antiTPO beyond laboratory reference limits were found by gynaecologists in 214 women (36.1%) and 141 of whom (23.8%) underwent endocrinological examination. In the women without known risk factors (n=91) we found undiagnosed autoimmune thyroiditis in 20 cases (22 %) and in 7 cases (7.7%) some degree of subclinical hypothyroidism was confirmed. Finally, 18 (19.8%) women had hypothyroxinemia in the 1^st trimester (fT4 average 8.76 pmol/L) with normal TSH levels. Altogether, a total of 45 women were succesfully identified (49.5% of the endocrinologically examined group without risk factors, i.e. 7.6% of the whole screened group) who warranted monitoring. Of 73 women (12.3%) who underwent screening and, despite recommendation, did not undergo endocrinological examination, there were 55 cases (9.3% of the screened group) with positive levels of antiTPO and with elevation of TSH above the upper normal limit. Conclusions: Of 592 women in the 6^th - 10^th week of pregnancy who underwent thyropathy screening, we newly diagnosed 3.4% of women with autoimmune thyroiditis, 1.2% with subclinical hypothyroidism and 3% with hypotyroxinemia, for whom n o thyropathy risk factor had been evident. Thyropathies were identified in 7.6% of probands. We believe that our results support the importance of universal screening in pregnancy.

Aims: Cancer patient's inherited genotype may influence his or her survival, but evidence for the role of these genetic differences in oral cancer survival has not yet been explored. Methods: The authors evaluated polymorphisms in the GSTM1 and CYP1A1 genes for associations with overall survival in 100 oral squamous cell carcinoma (OSCC) treated patients and 100 controls who were followed up for survival within 2 years of the date of completion of their treatment. Overall survival was evaluated in Kaplan-Meier survival functions and Cox proportional hazards models. Results: After adjustment for stage and histology, GSTM1null genotype was associated with shorter survival among OSCC patients, compared with GSTM1 present genotype. There was no association between CYP1A1 C genotype and survival in the overall study population. Conclusion: The study indicated a potential role for GSTM1 polymorphism in predicting the clinical outcomes of treated oral carcinoma patients.

Aims: To determine the effectiveness of second line treatments in patients with neovascular AMD who did not respond adequately to primary treatment. Methods: Retrospective, multicentre assessment. The frequency of primary treatment failure and outcomes of subsequent secondary treatment were assessed according to the type of primary treatment, type of CNV and change in BCVA over a 12 month period. Results: At the time of assessment 750 entries (750 treated eyes, 725 treated patients) had follow-up longer than 12 months. A treatment change required 7.7% subjects treated with ranibizumab, 20.5% with pegaptanib and 22% with PDT and verteporfin. Average BCVA of all patients at the beginning of primary treatment was 50.7 ± 3 letters and 43 ± 3.5 letters in 12^th month (P<0.001). The mean decrease in BCVA was 7.7 ± 0.6 letters during the first 6 months of observation. During the next 6 months, no significant change occurred. The change of primary therapy was required on average after 6.5 ± 2.1 months. Conclusion: BCVA loss was the most significantly decelerated in patients who received ranibizumab as a secondary therapy following unsuccessful treatment with pegaptanib sodium.

Aims: This study aimed to investigate the association of Hypoxia-inducible factor-1α (HIF-1α) C1772T and G1790A single nucleotide polymorphisms (SNPs) with: incidence, clinical type, severity of coronary atherosclerosis and coronary collaterals of coronary artery disease (CAD). Methods: The clinical data and genomic DNA were gathered in 958 subjects, including 560 controls and 398 patients with CAD. CAD was confirmed with coronary angiography (CAG). The genotypes for two SNPs were determined by high resolution melting after PCR amplification. Results: Neither the HIF-1α C1772T nor the G1790A genotype was significantly associated with CAD and, no gene-gene or gene-environmental interactions were identified. However, both HIF-1α C1772T and G1790A (P<0.05) alleles were associated with clinical type and formation of coronary collaterals (P<0.05). Patients carrying genotype CT (P=0.019, OR=4.905,91, 95% CI: 1.355-17.761) and GA (P=0.026, OR=3.052, 95% CI: 1.180-7.892) had significantly higher stable angina pectoris (SAP) than unstable angina pectoris (UAP) and acute myocardial infarction (AMI). The presence of HIF-1 genotype CT (P=0.016, OR=13.373, 95% CI: 15.468-32.709) and GA (P=0.001, OR=19.741, 95% CI: 8.125-47.966) predicted lower collateral formation and severity of CAD secondary to the absence of collaterals (r=0.242, P<0.001). Conclusions: We conclude that functional polymorphisms in the HIF-1α gene do not modify CAD risk but they are associated with the formation of coronary collaterals and clinical presentation of CAD.

Objective: The aim of the survey was to identify the needs of mothers to infants hospitalized in intensive care units (ICUs) and second, to assess the level of parental support provided by the health personnel. Methods: The sample consisted of 147 mothers to infants hospitalized in ICUs. The research was conducted over six months in ICUs for newborns at two hospitals in Ostrava. The study used two standardized questionnaires: The parental stressor questionnaire scale: Neonatal Intensive Care Unit which measures the degree of stress in parents of hospitalized infants and the questionnaire The Nurse Parent Support Tool which evaluates the level of parental support provided by nursing staff. Results: The highest level of stress was identified in the parental role. Specifically, the inability to help the child remain separate from the mother, a feeling of helplessness and inability to protect the child from painful procedures and the inability to feed her baby. Mothers evaluated the support of nursing staff in most of these areas as high. Top were rated the ability of the caring staff to respond well to the questions of parents and the mother's willingness to engage in childcare. Conclusion: Intensive care units for the newborn obviously need to be family-centered care and at the same time they must be aware of all the factors that can be sources of stress for the parents.Only in this way can stress be eliminated with positive impact on the relationship between mother and child.