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Background: Cholinesterases are a group of serine hydrolases that split the neurotransmitter acetylcholine (ACh) and terminate its action. Of the two types, butyrylcholinesterase and acetylcholinesterase (AChE), AChE plays the key role in ending cholinergic neurotransmission. Cholinesterase inhibitors are substances, either natural or man-made that interfere with the break-down of ACh and prolong its action. Hence their relevance to toxicology and pharmacology. Methods and Results: The present review summarizes current knowledge of the cholinesterases and their inhibition. Particular attention is paid to the toxicology and pharmacology of cholinesterase-related inhibitors such as nerve agents (e.g. sarin, soman, tabun, VX), pesticides (e.g. paraoxon, parathion, malathion, malaoxon, carbofuran), selected plants and fungal secondary metabolites (e.g. aflatoxins), drugs for Alzheimer's disease (e.g. huperzine, metrifonate, tacrine, donepezil) and Myasthenia gravis (e.g. pyridostigmine) treatment and other compounds (propidium, ethidium, decamethonium). Conclusions: The crucial role of the cholinesterases in neural transmission makes them a primary target of a large number of cholinesterase-inhibiting drugs and toxins. In pharmacology, this has relevance to the treatment of neurodegenerative disorders.

Aim: The aim of this study was to evaluate TSPY (testis specific protein on the Y chromosome) gene and 5'UTR (UnTranslated Region) polymorphisms in men with impaired fertility compared to fertile controls. Methods: We analyzed 72 infertile men and 31 fertile controls usingconventional sequencing analysis to find crucial SNPs (single nucleotide polymorphism) and other changes. Results: The most remarkable changes were found in the 1^st exon only. In one half of the both infertile men and fertile controls, the most frequent finding was 26 SNPs with a similar pattern. In the other half we found highly relevant changes, generating a stop codon in the first third of exon 1. Early termination cut down the protein by 78.5%. This kind of change was not found in the fertile controls. No correlation was found between the spermiogram and the changes leading to the stop codon. The distribution of men with deletions, insertion and higher gene copy number was not statistically different. Conclusion: The changes found in exon 1 in infertile men could fundamentally affect the process of spermatogenesis. These findings could significantly enhance our understanding of the molecular-genetic causes of male infertility.

Background: Obstructive sleep apnea (OSA) can activate pathological routes which can lead to insulin resistance, development of atherosclerosis and hypertension. The combination of hypertension and OSA has an additive effect on the development of atherosclerosis. As a number of studies have revealed, that the incidence of OSA in patients with myocardial infarction is likely to be high. Methods and results: We present a patient with acute myocardial infarction and no classical coronary artery disease risk factors: non-smoker, normal blood pressure, normal total and low-density lipoprotein cholesterol levels, borderline high-density lipoprotein cholesterol level, with good physical activity, no diabetes mellitus, no abdominal obesity, a negative family history. The only risk factor was untreated obstructive sleep apnea. The course of disease was complicated by subsequent in-stent restenosis and progression of atherosclerotic plaques, which led to the need for acute coronary artery bypass graft surgery complicated by consecutive in-anastomosis stenosis despite maximum cardiovascular therapy. One year of continuous positive airway pressure treatment was needed to stabilize his health condition, which is now stable for up to two years. Conclusions: Given the complicated course of ischemic heart disease in patients with OSA, we believe that OSA diagnosis would be advisable each time these patients with symptoms of myocardial infarction, ischemic heart disease and OSA are examined. Even more important, however, is proper treatment of the OSA when it is present.

Aim: To determine the incidence of postoperative nausea and vomiting (PONV), identify risk factors, assess treatment and its effectiveness. Design: A prospective, observational, questionnaire- and interview-based study. Setting. Standard and intensive care units of the following university hospital departments: abdominal, thoracic and vascular surgery; gynecology; plastic and esthetic surgery; urology; and traumatology. Material and methods: Adult patients scheduled for elective surgery who gave informed consent were enrolled. A questionnaire-based study was performed on the first postoperative day. The collected data relevant to PONV were statistically analyzed. Conclusion: The incidence of PONV was significantly lower than generally presumed and was related to the patient gender, type of surgery and overall health status. PONV was more frequent in obese patients and when drugs antagonizing opioids or muscle relaxants were used. Early administration of antiemetic agents led to considerably less discomfort.

Background: The introduction of the calcineurin inhibitors (CI) cyclosporine and tacrolimus into immunosuppressive protocols initiated a new era in organ transplantation with excellent short-term graft survival. Nevertheless, the chronic nephrotoxicity of these drugs represents a significant adverse factor limiting their long-term use. Patients treated with a CI can be at risk for developing renal failure and this problem is especially pronounced in patients after renal transplantation. Methods and Results: In a review paper we summarize the clinical aspects, histological manifestations and pitfalls of diagnostics of acute and chronic CI nephrotoxicity in patients after kidney transplantation. We look in detail at the disputed relationship between blood concentrations of cyclosporine and tacrolimus and histological manifestation of toxicity and summarize data showing that for toxic effects, local renal exposure to CI and their metabolites can play a more significant role than systemic exposure. We also include recent views on the pathophysiologic and molecular mechanisms underlying these changes; factors influencing local susceptibility to CI nephrotoxicity are discussed, including variability of expression and activity of P-glycoprotein and cytochrome P450. Last but not least we summarize our own experience with clinically manifest and subclinical forms of nephrotoxicity and their impact on the progression of chronic graft changes. Conclusions: Owing to their unique effects, CI remain the cornerstone of most immunosuppressive protocols for renal transplantation. Together with optimization of local kidney exposure to CI and their metabolites, efforts to reduce systemic levels as much as possible are the most important preventive measure for reducing toxic renal graft damage.

Background: Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. Materials and Methods: An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Results: Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. Conclusion: The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

Background: The purpose of this paper is to describe two cases of desquamative gingivitis (DG) that were treated with a topic gel containing clobetasol propionate and Calendula officinalis L in an acetate tray over two years. Methods: Two patients with a diagnosis of lichen planus presenting as DG who had undergone previous treatments for this condition with no significant results, were treated by a handling gel containing clobetasol, nystatin, Calendula oficcinalis L and pectin in custom trays. Results: Both patients had remission of symptoms while using the trays and after they stopped the treatment, the symptomatic outbreaks were delayed and presented as less severe symptoms in the two years follow-up. The treatment is aimed primarily at reducing the length and severity of symptomatic outbreaks desquamative gingivitis Conclusion. This handling gel using a tray may be an efficacious treatment of desquamative gingivitis.

Background: Phase II biotransformation reactions (also 'conjugation reactions') generally serve as a detoxifying step in drug metabolism. Phase II drug metabolising enzymes are mainly transferases. This review covers the major phase II enzymes: UDP-glucuronosyltransferases, sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases (mainly thiopurine S-methyl transferase and catechol O-methyl transferase). The focus is on the presence of various forms, on tissue and cellular distribution, on the respective substrates, on genetic polymorphism and finally on the interspecies differences in these enzymes. Methods and Results: A literature search using the following databases PubMed, Science Direct and EBSCO for the years, 1969-2010. Conclusions: Phase II drug metabolizing enzymes play an important role in biotransformation of endogenous compounds and xenobiotics to more easily excretable forms as well as in the metabolic inactivation of pharmacologically active compounds. Reduced metabolising capacity of Phase II enzymes can lead to toxic effects of clinically used drugs. Gene polymorphism/ lack of these enzymes may often play a role in several forms of cancer.

Aim: To determine the accuracy of the modified Mallampati test for predicting difficult tracheal intubation. Design: A cross-sectional, clinical, observational, non-blinded study. A quality analysis of anesthetic care. Setting. Operating theatres and department of anesthesiology in a university hospital. Material and methods: Following the local ethics committee approval and patients' informed consent to anesthesia, all adult patients (> 18 yrs) presenting for any type of non-emergency surgical procedures under general anesthesia requiring endotracheal intubation were enrolled. Prior to anesthesia, Samsoon and Young's modification of the Mallampati test (modified Mallampati test) was performed. Following induction, the anesthesiologist described the laryngoscopic view using the Cormack-Lehane scale. Classes 3 or 4 of the modified Mallampati test were considered a predictor of difficult intubation. Grades 3 or 4 of the Cormack-Lehane classification of the laryngoscopic view were defined as impaired glottic exposure. The sensitivity, specificity, positive and negative predictive value, relative risk, likelihood ratio and accuracy of the modified Mallampati test were calculated on 2x2 contingency tables. Results: Of the total 1,518 patients enrolled, 48 had difficult intubation (3.2%). We failed to detect as many as 35.4% patients in whom glottis exposure during direct laryngoscopy was inadequate (sensitivity 0.646). Compared to the original article by Mallampati, we found lower specificity (0.824 vs. 0.995), lower positive predictive value (0.107 vs. 0.933), higher negative predictive value (0.986 vs. 0.928), lower likelihood ratio (3.68 vs. 91.0) and accuracy (0.819 vs. 0.929). Conclusion: When used as a single examination, the modified Mallampati test is of limited value in predicting difficult intubation.

Background: Hemolytic disease in the newborn with its typical signs and poor prognosis has been known for centuries. Historically it can be divided into three pathological states which are fetal hydrops (hydrops fetus universalis), neonatal jaundice (icterus neonati gravis familiaris) and fetal anemia (anemia neonati). Almost 70 reports with quite accurate descriptions were found up to the end of 19th century. The patho physiological basis of the condition began to be studied at the beginning of the last century and the development of our knowledge is an example of the cooperation between pathologists, pediatricians, hematologists and later, obstetricians, immunologists and geneticists. Despite all the advances in this field it remains a serious disease up to this time. It is not managed successfully in all cases and despite successful immunological prophylaxis there are cases when we need to administer intrauterine transfusion based on the information received by dopplerometric measurement of arteria cerebri perfusion and fetal blood sampling. Methods: Review of lover cited literature. Conclusion: The history of the hemolytic disease in the newborn, its condition and approaches to it has not been recently compiled in the Czech Republic.

Aim: To evaluate the therapeutic effect of resynchronization in patients with chronic heart failure who are symptomatic despite adequate pharmacological medication. Sample and methodology: 118 patients with chronic heart failure, mostly dilated cardiomyopathy and ischaemic heart disease, with depressed systolic function, decreased left ventricular ejection fraction (LVEF) and left bundle branch block wide QRS complex, underwent implantation of the biventricular system between the years 2000-2006. We assessed changes in the NYHA functional class, hemodynamic parameters acquired during right heart catheterization, the maximum oxygen consumption during stress spiroergometric examination, as well as echocardiographic parameters. Results: A statistically significant improvement was found in the NYHA functional class (from 2.8 ± 0.4 to 2.3 ± 0.5 after 3m, p < 0,001 and to 2.5 ± 0.6 after 12m, p < 0,01 respectively), as well as an increase in the maximum oxygen consumption during spiroergometric examination (VO2 max from 14.1 ± 3.1ml/kg/min to 15.3 ± 3.1 ml/kg/ min, p < 0,001 and to 15.3 ± 2.5 ml/kg/min, p = NS respectively). In regard to hemodynamic parameters, there were increases in cardiac output and cardiac index after three months. After 12 months the change was not statistically significant (CO from 3.9 ± 1 l/min to 4.2 ± 0.9 l/min, p < 0,05, and to 4.1 ± 0.9 l/min, p = NS, CI from 2 ± 0.5l/kg/min to 2.2 ± 0.4l/kg/min, p < 0,05, and to 2.1 ± 0.4 l/kg/min, p = NS). Mean pulmonary artery pressure, as well as pulmonary capillary wedge pressure was reduced after 3, as well as after 12 months to a statistically significant degree (MPA from 29.1 ± 11.5 mm Hg to 23.9 ± 10.3 mm Hg, p< 0,001, and to 24.9 ± 11.8 mm Hg, p < 0,01 respectively, and PCWP from 19.9 ± 9.5 mm Hg to 15.2 ± 9.2 mm Hg, p < 0,01, and to 15.6 ± 9 mm Hg, p < 0,01 respectively). In regard to echocardiographic parameters, there was an increase in LVEF, a reduction in the end-diastolic diameter of the left ventricle, as well as a statistically significant reduction in severity of mitral regurgitation after 3, as well as 12 months (LVEF from 20.5 ± 5.3%, to 23 ± 6.5%, p < 0,001, and to 24.5 ± 8%, p < 0,001, LVEDD from 69 ± 9 mm to 68 ± 9 mm, p < 0.01 and to 65 ± 12 mm, p< 0.01 respectively, mitral regurgitation from 2.2 ± 0.8 to 1.9 ± 0.8, p< 0.001, and to 2 ± 0.8, p < 0.001. Conclusions: In patients with chronic heart failure, resynchronization therapy leads to reduced symptoms, reduction in dyspnea and to improvements in cardiac performance due to increase in the systolic function of the left ventricle and hemodynamic changes.

The Supplement 1 of Biomedical Papers, Vol. 151 (2007) contains contributions presented at the 57th Pharmacological Days, in other words, at the 57th Czech and Slovak Pharmacological Meeting. This meeting takes place in Olomouc, on September 12–14, 2007. Palacky University at Olomouc is pleased to host this event which represents a traditional gathering of pharmacologists, toxicologists and scientists interested in fi elds overlapping with these two broadly defi ned fi elds of biomedical sciences. It is also a good tradition that this meeting is a truly Czecho-Slovakian one with participants coming from both sides of the friendly borders between Czech and Slovak Republics. Olomouc is, in many aspects, an almost ideal place for meetings of scientifi c communities. It is a city with the second oldest University in the Czech Republic (after Charles University of Prague), founded in 1573 which is also known for their famous former students, e.g. Albrecht Eusebius Valdstejn (Wallenstein) or Gregor Mendel. Its location, not much distant from Prague, Bratislava, Cracow, Vienna or Budapest makes Olomouc a lively city full of students and scholars coming from all places of the world. We believe that the 57th Pharmacological Days will off er a good opportunity for mutual exchange of ideas and for meeting of friends and coworkers.

Background: Both patients and psychotherapists can experience strong emotional reactions towards each other in what are termed transference and countertransference within therapy. In the first part of this review, we discuss transference issues. Although not usually part of the obvious language of cognitive behavioral therapy (CBT), examination of the cognitions related to the therapist, is an integral part of CBT, especially in working with difficult patients. In the second part, we cover counter-transference issues. We describe schematic issues that give rise to therapist counter-transference and explain how this interacts in different types of patient therapist encounter. We also examine ways in which the therapist can use CT to help him/her modify the countertransference and, in the process, assist the patient. Methods: PUBMED data base was searched for articles using the key words "therapeutic relations", "transference", "countertransference", "cognitive behavioral therapy", "cognitive therapy", "schema therapy", "dialectical behavioral therapy". The search was repeated by changing the key word. No language or time constraints were applied. The lists of references of articles detected by this computer data base search were examined manually to find additional articles. We also used the original texts of A. T. Beck, J. Beck, M. Linehan, R. Leahy, J. Young and others. Basically this is a review with conclusions about how therapists can manage transference issues. Results: Transference. The therapist should pay attention to negative or positive reactions towards him/ her but should not deliberately provoke or ignore them. He/she should be vigilant for signs of strong negative emotions, such as a disappointment, anger, and frustration experienced in the therapeutic relationship by the patient. Similarly he/ she should be alert to exaggerated positive emotions such as love, excessive idealization, praise or attempts to divert the attention of therapy onto the therapist. These reactions open space for understanding the patient's past and actual relations outside the therapy. Countertransference. The therapist should be aware of countertransference schemas as they apply to him/her. He/she should monitor his/her own feelings that indicate countertransference. Further, the assistance of and discussion with supervisors and colleagues is useful in regard to countertransference even in experienced therapists. Countertransference can be used as an open window into the interpersonal relations of the patient. Conclusions: Both the literature and our experience underscore the importance of careful and open examination of both transference and counter-transference issues in CBT and their necessary incorporation in the complete management of all patients undergoing CBT.

Aim: The aim of this prospective study was to assess the presence of sinus rhythm and atrial transport function after surgical ablation of atrial fibrillation using cryoenergy, and to evaluate predictors of the success of the procedure. Methods: Between January 2005 and September 2006, 100 consecutive patients underwent left atrial cryoablation as a concomitant surgical procedure (46 patients with paroxysmal or persistent atrial fibrillation and 54 with permanent atrial fibrillation). Mitral valve surgery was performed in 74%. The mean and the median times of follow-up were 20 ± 8.5, and 24 months respectively. Atrial mechanical function was assessed by echocardiography. Results: Sinus rhythm was achieved during the postoperative follow-up in 71-81% of patients - significantly more often in the group with paroxysmal and persistent atrial fibrillation (90-98%), than patients with permanent atrial fibrillation prior to surgery (51-65%) (p<0.002). At 12 and 24 months after the surgery, a total of 68.2% and 51.2% of the patients were free from atrial fibrillation; 73.9% and 60.7% of the patients from the paroxysmal and persistent atrial fibrillation group, and 60.3% and 37.7% of patients with permanent atrial fibrillation (p=0.05). Five per cent of patients required postoperative permanent pacemaker implantation. An effective left and right atrial mechanical function was detected in 70-90%, and 96-98% of patients with sinus rhythm respectively. The following circumstances were identified as negative predictors of the presence of sinus rhythm after the ablation procedure: growing diameter of the left atrium, the duration of atrial fibrillation and the severity of mitral and tricuspid regurgitation before surgery (p<0.05). Restoration of the left atrial transport function was negatively predicted by the preoperative diameter of the left atrium, the presence of mitral valve stenosis and the severity of tricuspid regurgitation (p<0.05). A total of 95.4% of patients were free from stroke at one-year follow-up, and 94.1% at 2 years after surgery. Conclusion: Stable sinus rhythm and effective left atrial transport function are the main factors resulting in decreased morbidity after successful ablation of atrial fibrillation. A careful post-operative follow-up of the patients and individualised treatment are necessary.

Introduction: Since atherosclerosis may in part be an inflammatory disease, circulatory factors related to inflammation may be predictors of coronary artery disease. The aim of this study was to evaluate the association between the level of some circulating biomarkers and the extent of coronary artery disease. Methods: Blood samples were taken from 128 patients with stable forms of coronary heart disease. Macrophage chemoattractant protein-1 (MCP-1), matrix-metalloproteinase-3 (MMP-3), soluble CD40 ligand (sCD40L) and soluble tumour necrosis factor receptor-2 (sTNFR2) were measured by ELISA. Coronary angiography and grading with the SYNTAX score followed. Results: There was no significant interdependence of circulating MCP-1, sCD40L, sTNFR2 levels and SYNTAX score. MMP-3 levels were significantly different in subgroup with coronary artery disease (SYNTAX score > 0): 38.1 µg/l (13.6; 84.1) and subgroup without coronary artery disease (SYNTAX score = 0): 20.4 µg/l (13.1; 82.8), p=0.001. According to the Spearman correlation coefficient there was significant association between MMP-3 level and SYNTAX score (0.358, a=0.05). Conclusions: Our data suggest association between the extent of coronary artery disease and circulating MMP-3. We failed to demonstrate any association with the other investigated biomarkers.

Background: N1,N12-diacetylspermine, a diacetylpolyamine which was recently identified in urine, appeared to be a useful tumor marker for a number of cancers. No valid data on urine diacetylspermine concentration in patients with urinary bladder cancer exist. Aim: Evaluation of urine N1,N12-diacetylspermine concentrations in individuals with urinary bladder cancer. Methods: Urine samples were used from 36 patients with urothelial tumors of the urinary bladder and from 30 patients with benign urological diseases. Urine was collected before cystoscopy. Enzyme-linked immunoabsorbent assays (ELISA) were performed for diacetylspermine from urine. Results: Urine diacetylspermine did not differentiate in individuals with urinary bladder cancer from controls (medians 171.5 vs 143.8, p = 0.64). Its efficacy for urinary bladder cancer detection was not shown. Conclusions: Urine N1,N12-diacetylspermine is probably not a useful marker for urinary bladder cancer.

Aims: There is no standardized protocol for measuring glycemic index (GI) that takes time-of-day effects into account. The software DegifXL2 and Medtronic-Minimed's CGMS and Solutions, makes the GI calculation at breakfast and dinner time possible. The aim of this study was to assess the enhanced data processing software (DegifXL4) enabling the GI calculation at breakfast, lunch, afternoon snack and dinner times. Methods: The glucose levels of 20 healthy volunteers were monitored after they consumed either 50 g of glucose or one of ten alternative foodstuffs either for breakfast and dinner or for lunch or snack. Within the 9-day test period, 10 such meals were monitored in 3 replicates for each volunteer. Specifically, CGMS was used to monitor plasma glucose levels at 5-minute intervals for a period of 120 min following the foodstuff ingestion. Results: Using the enhanced spreadsheed DegifXL 4, a total of 640 profiles were obtained and 491 (77 %) accomplished the criteria for further processing. The percentage of successful tests in each foodstuff varied from 57 to 87 %. Conclusions: The use of the new software DegifXL4 offers accurate GI estimates for foodstuffs eaten for breakfast, lunch, snacks and dinners in three replicates. In combination with the CGMS Solutions Software is DegifXL4 an enhanced efficient and comfortable way to routinely measure GI values.

Background: We analyzed data gathered from initial and repeated prostate biopsies at the University Hospital in Olomouc, Czech Republic. We evaluated the diagnostic yield of repeated transrectal ultrasound (TRUS) guided biopsies. We also assessed whether the result of the repeated biopsy depended on the benign diagnosis of the previous biopsy. Methods: From June 2006 till December 2008, the total of 794 men underwent a TRUS guided biopsy. The following parameters were recorded for each patient: age, total Prostatic Specific Antigen (PSA) level, free PSA level, digital rectal examination record, total prostate volume, and the histo-pathological evaluation. For patients undergoing a repeated biopsy, the histo-pathological result of the previous biopsy was also available, as well as the total number of previous biopsies and the time since the last biopsy. These data were analyzed using standard statistical methods. Results: Initial biopsy was positive for prostate cancer in 157 out of 566 men (27.7%). The total PSA level was confirmed to be a significant (P < 0.001) predictor of prostate cancer. The ratio of free PSA to total PSA (the socalled PSA index) was found to be significantly lower (P < 0.001) for patients suffering from adenocarcinoma. A total of 191 men underwent a repeated biopsy. The repeated biopsy was positive for adenocarcinoma in 39 cases (20.4%). Although this yield is lower, the significance is at the threshold (P = 0.04700). In the group of rebiopted men, total PSA level and PSA index were again significant (P = 0.0024 and P = 0.0015 respectively) predictive factors for prostate carcinoma. The diagnostic yield of repeated biopsy was assessed with respect to the most common types of the benign findings in the previous biopsy - adenomyomatous hyperplasia, inflammation, high grade prostatic intraepithelial neoplasia, and suspected adenocarcinoma. No significant difference in the diagnostic yield was found (P = 0.38431). Conclusions: Total PSA level and PSA index are the most significant precursors of adenocarcinoma in both initial and repeated biopsy. The histo-pathological result of a repeated biopsy was found to be independent of the type of benign diagnosis of the previous biopsy. A substantial number of prostate cancer is diagnosed in repeated biopsies which advocates for the indication of a repeated biopsy in case of a negative result of the initial one.

Aims: Stuttering is a serious health and social problem that can distinctively affect not only the mental development of an individual but also his life possibilities, including social fulfilment and his general life prospects. The etiology of stuttering is however unknown and that is why it is not possible to treat it causally. This pilot study takes into account the hypothesis of bronchial constriction as a negative factor in stuttering and investigates the effect of the long-acting bronchodilator formoterol fumarate on stuttering in 42 patients. Methods: Patients were divided in 2 groups - A (school children and juveniles) and B (adults 18-25 resistant to other treatment). The medicine was administered once a day in the morning in a dose of 12 µg for the total period of 6 months. The prime outcome parameter - severity of stuttering - was evaluated using the ordinary scale (McGill Pain Questionnaire). The evaluation was done by an examining physician during visits to the centres and by the patients themselves (in cases of the youngest with the assistance of a parent) in a daily diary. Results: A non-parametric pair test (Wilcoxon signed rank test) was used to compare the average marks in the whole set of patients. During the six moth period of administration of Foradil® the speech fluency improved. The average number of dysfluent words decreased from 10.5 ± 1.3 to 6.6 ±0.97. Conclusion: The average mark of speech fluency evaluated by the physicians between the period of non use of Foradil® and the six month period after the use of Foradil® improved from 2.95 ± 0.76 to 1.95 ± 0.56 (as proved by the chi-square test, p<0.0001). The evaluation of speech fluency of balbuties uses the logopedic practices. Other clinical evaluations of speech fluency are not known.

Background: This is a review of current knowledge on the use of saliva, gingival cervical fluid and mucosal transudate in the detection of some oral and systemic diseases as well as drugs. Oral fluid is a diagnostic medium that can be easily collected and with minimal invasion but it has been neglected in the past. Today, saliva is being used more often to diagnose: HIV virus, oro-facial and systemic tumors, cardiovascular disease and in detecting addictive substances. Neutropil levels in saliva may also indicate successful bone marrow transplant. Oral fluid is now systematically being researched and oral fluid analysis is being compared with the analysis of other diagnostic media such as blood and urine . A number of recent studies have focused on oncogenic marker detection and its monitoring in saliva. The latest clinical and laboratory findings on diagnostic markers of oropharyngeal carcinoma in oral fluid could be the beginning of their wider use as a diagnostic medium. Oral fluid can also be also used to diagnose other malignancies such as breast cancer which was one of the first malignant tumors to be detected using genetic protein biomarkers. Raised levels of CA15-3 and the epidermal growth factor (EGF) receptor have been found in patients with breast cancer and elevated levels of CA 125 and the glycoprotein complex in the saliva of ovarian cancer patients. Conclusion: Doubtless, the diagnostic value of saliva, aided by current technological development will increase rapidly in the near future.

Objectives: The purpose of this prospective controlled trial was to assess the efficacy of three commercially available glucose products, (1) buccal glucose spray, (2) liquid sugars, and (3) dextrose tablet, on the evolution of plasma glucose concentration (PG). Methods: Sixteen healthy volunteers aged 21.8 ± 0.78 y (mean ± SE), BMI 23.5 ± 0.84 kg/m², tested their PG over the course of 3 sets of 4 sessions (S) each: S₀-control fasting, S₁-buccal administration of 10 glucose spray-doses (0.84 g of glucose) without swallowing; S_2- consumption of 1 sachet (13 ml) of liquid sugar (ca. 5.2 g glucose, 5.2 g fructose, 5.2 g sucrose); S_3- consumption of one dextrose tablet (6 g). PG was tested in finger-prick capillary blood using a personal glucometer Linus at the start, and at 5, 10, 15, 20 and 30 min. The means of 3 respective sessions for each of the 16 subjects were analyzed. Results: The Wilcoxon signed rank test revealed no significant differences between changes in the mean PG at the start vs. 5-minute interval either in control, or any intervention sessions. Analysis of regression coefficients after 30 min compared to the control session, demonstrated an increase in PG with the sachet of liquid sugars (0.068 mmol/l/min, p = 0.001) which was greater than a single dextrose tablet (0.052 mmol/l/min, p = 0.002), but no significant PG increase was found after buccal glucose spray. Conclusion: Liquid sugars or dextrose tablets, but not the buccal glucose spray, are effective means to increase PG within 10 minutes after ingestion.

Background: Angiogenesis plays an important role in maintaining adequate oxygen delivery, and nitric oxide (NO) is a potential regulator of angiogenesis. NO is synthesized through three isoforms of NO synthase (NOS). It is hypothesized that the NO derived from inducible NOS (iNOS) may promote survival of ischemic tissue through angiogenesis. To test this hypothesis, we investigated the effect of iNOS deficiency (by L-NIL) on angiogenesis in a hindlimb ischemia model. Methods: Thirty-two male wistar rats randomly divided into four groups. In groups 1 & 2, hindlimb ischemia was induced by ligation of femoral artery and they received L-NIL and saline respectively. The animals in groups 3 and 4 also received L-NIL and saline respectively without surgical procedure. After 21 days, the serum concentration of nitrite, capillary density and expression of HIF1α were determined. Results: Serum nitrite levels were significantly lower in L-NIL groups (p<0.05). The capillary density in group 1 (ischemia + L-NIL) was significantly different from group 2 (ischemia + saline); group 1: 360.33 ± 77.02, group 2: 549 ± 81.85 /mm² , p<0.05) .In addition, expression of HIF1α was significantly increased in ischemic groups (p<0.05). Conclusion: Selective inhibition of iNOS by L-NIL inhibits angiogenesis in a hindlimb ischemic rat model. In addition, ischemia induces expression of HIF1α in hypoxic tissue.

Aims: To assess the impact of cognitive task solving on respiratory and cardiovascular parameters. Methods: The ML870B80 Exercise Physiology System was used to record concurrently with EEG, the cardiorespiratory and metabolic functions of subjects during cognitive activity. The Expired Minute Ventilation (V_E), Oxygen Consumption (V_O2), Carbon Dioxide Production (V_CO2) and Average Heart Rate (BPM) were ascertained for four periods: (1) rest or starting period, (2) reference period, (3) cognitive task solving period and (4) recovery period. Each period was defined by the type of presented visual stimuli and by the prearranged cognitive activity related to visual stimuli. The personality traits of participants were also determined. Results: The momentary functional state of subject's brain (i.e. the period of the experiment) determined the average values of all measured parameters. During the cognitive task solving period the average V_E, V_O2 and V_CO2 reached the lowest values while the HR behaved reversely - it was the highest in the cognitive task solving period. Further, the average V_E, V_CO2 and HR values but not V_O2 value differed significantly from average values for the same variable measured in the rest period. Conclusion: The changes in respiratory variables during the cognitive task solving period predicate the whole-body metabolic rate rather than the energy metabolism of the brain alone. However, the heart rate related to some personality traits of the subject has a tighter relation to brain's energy metabolic rate during the cognitive task solving - it affects the oxygen supply of the brain.

Background: Nanomaterials are at the leading edge of the rapidly developing field of nanotechnology. Magnetic nanoparticles for cancer therapy and diagnosis have been developed on the basis of their unique physico-chemical properties not present in other materials. Their versatility is widely exploited in such diverse techniques as cell and macromolecule separation and purification, immunoassays, targeted drug delivery, controlled material release, electromagnetic hyperthermia, gene therapy, or magnetic resonance imaging. In this review we concentrate on the physical principles of magnetic drug targeting and biomedical applications of this technique. Methods and results: We examined several databases, PubMed, ISI Web of Knowledge, and Scopus, for the period 1985-2009, with specific attention to studies that used targeting of magnetic nanoparticles especially in the therapy and diagnostics of tumors. We have also presented several of our own results on theoretical simulations of magnetic particle motion in external magnetic field. Conclusions: We found growing number of published papers in this field of nanomedicine, showing the almost unlimited potential of magnetic nanoparticles in the field of experimental and clinical oncology.

Background: Intensive selfmonitoring is an important and cost-demanding part of diabetes treatment. Continuous glucose monitoring (CGM) using transcutaneous sensors offers "real time" information on glycemia. In the present study, we assessed the therapeutic efficacy of CGM on metabolic control using two different statistical methods: linear regression and "survival analysis". Objectives: (1) to assess the therapeutic efficacy of CGM on metabolic control using two different statistical methods: linear regression and survival analysis; (2) to demonstrate the particular advantages of each statistical method. Methods: A total of 42 persons with diabetes mellitus treated by means of an insulin pump participated in this study. According to the means of selfmonitoring persons with diabetes were divided into two groups: 1. intervention group of 17 persons using CGM, 2. control group of 25 persons using a glucometer. Each person was followed for a period of three months. At the beginning of the study and at the end of each month HbA1c was determined. Results: Both the regression analysis and survival analysis brought evidence of significant changes of the HbA1c in either of the groups. The method of linear regression enables to analyse the evolution of HbA1c in each individual person followed by comparison of the groups. The survival analysis demonstrated that the probability of HbA1c decrease to the predefined level as well as its further maintaining at this level was higher in the CGM group. The mean time interval necessary to HbA1c decrease was shorter in the CGM group. Conclusions: The efficacy of CGM was demonstrated. In addition to linear regression, survival analysis appears to be an useful complementary method in the statistical evaluation of the treatment efficacy.

Aims: Heart transplantation (HTx) is the most effective therapy in patients with end-stage heart failure. Diabetesrelated complications are relative contraindications for heart transplantation. The aim of our study was to analyse the impact of DM (diabetes mellitus) at the time of heart transplantation and new-onset post-transplantation DM on long-term survival. Methods: A retrospective database analysis was performed on all patients who had undergone HTx at our institution between 4/1997 and 9/2007. Patients were divided into three groups: Group A - patients without DM; Group B - patients with new onset of DM after HTx; Group C - patients with DM prior to HTx. Results: Patients with DM before the surgery were more obese, their BMI was 27.7 ± 2.90, compared to groups A and B with BMI of 24.7 ± 3.37 and 25.3 ± 3.64 respectively (p = 0.0003). Patients in group B had statistically significantly higher risk of developing acute rejection (G 1B and more according to International Society of Heart and Lung Transplantation - ISHLT - classification) (p = 0.0350). The incidence of infections between individual groups showed no statistically significant differences (p = 0.5839). Five-year survival in group A was 82%, 10-year survival was 73%. Corresponding numbers for group B were 86% and 78%, for group C 86% and 83%. Differences between groups were not statistically significant (p = 0.2560). Conclusions: DM in patients after heart transplantation in our study had no effect on long-term survival of patients. Post-transplantation DM increases risk of acute rejections. Pre-transplantation DM was associated with excessive bodyweight or obesity.

Background: Anatomical terminology serves as a basic communication tool in all the medical fields. Therefore Latin anatomical nomenclature has been repetitively issued and revised from 1895 (Basiliensia Nomina Anatomica) until 1998, when the last version was approved and published as the Terminologia Anatomica (International Anatomical Terminology) by the Federative Committee on Anatomical Terminology. Methods and results: A brief history of the terminology and nomenclature development is mentioned, along with the concept and contributions of the Terminologia Anatomica including the employed abbreviations. Examples of obsolete anatomical terms and their current synonyms are listed. Clinicians entered the process of the nomenclature revision and this aspect is demonstrated with several examples of terms used in clinical fields only, some already incorporated in the Terminologia Anatomica and a few obsolete terms still alive in non-theoretical communication. Frequent mistakes in grammar and orthography are stated as well. Conclusion: Authors of the article strongly recommend the use of the recent revision of the Latin anatomical nomenclature both in theoretical and clinical medicine.

AIM: Bendable and angulated single-piece implants are used alternatively to screwable abutments in two-piece dental implant designs. Though used frequently, data on the stress distribution within such implants are not available and the question whether the bending contributes to fracture resistance has not been addressed. METHODS: We used the method of finite element to identify von Mises stresses and maximum stresses in bent and non-bent but angulated implants. Implants with one (e.g. applicable to screw designs) or two (applicable to basal implants) bending areas were the variables under investigation. RESULTS: For bends up to 13 degrees we discovered that if there is only one bend, the maximum stress is in the bent area. If two bends are made in two different bending areas, the maximum stresses are distributed between the two and, if either one of the bent areas is machined, there are no residual stresses within the implant body in this area. The maximum stresses are always located near the base-plates. The absolute value of the maximum stress is higher because no residual stresses are available to compensate stresses that stem from loading. CONCLUSION: Assuming that all other parameters are equal, bendable (basal) implants show a more even stress distribution along the vertical implant region than identically shaped implants with a machine-angulated area. Bendable basal implants therefore probably resist masticatory forces better than pre-angulated, machined implants, and unbent implants which provide a thin region in the vertical implant area.

Background: Implantable cardioverter defibrillators (ICD) are mobile implantable cardiac devices for immediate treatment of live threatening ventricular arrhythmias. However, these devices can affect patients, physiologically, psychologically and have effects on electrical devices. Case report: The case of a 61-year-old patient is reported. The patient came for regular 3-months visits with his ICD and complained about electromagnetic interference with all household electrical appliances, especially refrigerator and digital television set-top box. He described several phantom shocks when he came close to the electrical appliances. He noted the exact times and symptoms of the episodes but the device memory did not record anything. Conclusion: This case demonstrates the rare occurrence of psychological intolerance to implanted ICD shortly after implant. The device was programmed for higher sensitivity. The patient was calmed and reassured about the reprogramming.