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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

Iterative reconstruction of cerebral CT examinations enables reduction of both effective and organ eye lens dose by one third compared to the standard filtered back projection, without signficant loss of image quality.

This is the first study to describe the high prevalence of isolated exercise-only induced heart failure with normal ejection fraction (HFNEF) reaching 58% in a cohort of 81 post-heart transplant patients with normal left ventricular ejection fraction. This finding explains their low exercise tolerance due to exertional dyspnea and/or fatigue. Of the noninvasive parameters obtained at rest, multivariate regression analysis identified left ventricular mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF.

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.

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.

High tension and normal tension glaucoma are regarded worldwide as "one disease". Our study shows the differences between the two diagnostic groups.

This work describes the effect of two positive mutagens in the development of ciprofloxacin resistance in Salmonella Typhimurium. The mechanism of resistence was also studied in isolated resistant strains. Low concentrations of 2-nitrofluorene (2NF) and 3-(5-nitro-2-furyl) acrylic acid (5NFAA) significantly increased mutation frequency, leading to ciprloxacin resistance. 2NF was the best inducer of mutations in the gyrA gene and in regulating genes affecting synthesis inhibition of outer membrane porins. 5NFAA effected overproduction of efflux pumps.

This study reports no impact of primary chemotherapy delay resulting in reduced relative dose intensity of administered cytostatics on the outcome of patients with Hodgkin's lymphoma if the dose density of these drugs had remained the same according to appropriate protocol. Thus, time intensification of some therapeutic protocols appears to have no significant impact on the prognosis of patients with Hodgkin's lymphoma..

The experimental application B-Mode Assist with a graphical user interface (GUI) in MATLAB was developed for digital morphometric analysis of substantia nigra images using transcranial sonography. The aim of this study was to assess the utility of this experimental application. The observers demonstrated a high level of mutual agreement and each obtained highly consistent morphometric measurements over three successive repetitions. The agreement in the detection of substanita nigra pathology between visual and digital image analysis was 97.8% of the evaluated images. The present study demonstrates the high repeatability and reproducibility of substantia nigra measurements with "almost perfect" inter-observer and intra-observer agreement using the developed application B-Mode Assist.

Background: Malignant pleural effusions accumulate in the space between the visceral (inner) layer covering the lungs and the parietal (outer) layer covering the chest wall. Larger effusions compress the pulmonary parenchyma resulting in increasing dyspnoea. Treatment is always local and palliative. Among others, chemical pleurodesis using talc can be performed in selected patients. Talc is hydrated magnesium silicate (chemically H₂Mg₃(SiO₃)₄) and has been used for pleurodesis since 1935. Videothoracoscopic talc powder insufflation (talc poudrage) is the most effective.However, markers of inflammatory reactions to extraneous substances like talc are not fully understood. The aim of this study was to assess the course of local inflammatory changes in the pleural cavity after talc insufflation. Methods: The Department of Cardiac Surgery of the Faculty of Medicine and University Hospital in Hradec Kralove, treated 47 patients aged 65 on average; 29 males and 18 females with proven recurrent malignant pleural effusion of various aetiologies from January 2009 to December 2010. They were retrospectively divided into group A (40 patients) without recurring effusion, and group B (7 patients) with recurring effusion and the need for thoracentesis or chest drainage during the 9-month monitoring. Results: Major findings were made in soluble forms of cell receptors. Group B showed statistically higher levels of the anti-inflammatory form of sCD-163 receptor in pleural fluid before the talc poudrage. This showed limited ability to create an adequate inflammatory response to external stimuli. This group also showed lower levels of the inflammatory form of sTLR-2 receptor immediately after the talc insufflation. This revealed low local reactivity to external stimuli. The effect of the treatment was not influenced by morphologic tumour type. No statistically significant differences in postoperative complications were found. This confirmed the safety of both videothoracoscopy and treatment. Conclusions: There was no correlation between the type of malignant affection and the outcome of the chemical pleurodesis. Patients with relapsing effusion have higher values of concentration of anti-inflammatory sCD-163 in pleural fluid even before the application of talc, and lower levels of concentration of inflammatory sTLR-2 immediately after application of talc.

The mechanism of the activity exerted by a progesterone-carbachol derivative is described.

This study focuses on the effect of genetic variability in circadian genes (Period3) as a potential risk factor for chronic heart failure or factor modulating severity of heart failure.

Background: Variants of the immune response genes (IRG) are considered a potential source of interindividual differences in both innate and adaptive immune responses. A large number of gene polymorphisms have been reported as alternative forms of the IRG nucleotide sequence with important functional consequences for the structure/expression of immune response molecules. Accordingly, IRG polymorphisms are considered responsible for various monogenic diseases. They may also affect individual predisposition to complex diseases or modify their clinical course. Methods and Results: In this review we define IRG polymorphism including its potential functionality. Common approaches used for the investigation of IRG polymorphisms are next briefly described. We then review current approaches (including genome - wide studies) for assessing the importance of particular IRG variants in the susceptibility to and clinical course of complex diseases. Finally, based on our own experience and on the literature, we illustrate current knowledge of the genetic component of two selected complex diseases (sarcoidosis and coronary artery disease). Conclusions: Despite major advances in genotyping technology and general knowledge of the implications of IRG in the susceptibility to complex diseases, the potential clinical application of these approaches still faces major challenges.

Background: For more than 20 years, infection with the human papillomavirus (HPV) has been of a matter of interest not only to gynecologists but also to maxillofacial surgeons and othorhinolaryngologists. HPV is generally known to be involved in cervical cancer. Recently, there are many clinical studies pointed out the potentially dangerous connection between HPV infection and head and neck carcinomas (HNC). HPV infection was identified as a possible etiological factor in 15-30% of HNC. Methods: Aim of this article is to summarize the recent knowledge about the HPV infection with regards to etiology of head and neck cancer. Results: It has been proven that HPV infection is related to development of head and neck cancer and that the sexual behavior has played an important role in the viral transmission. HNC of viral etiology have been observed mostly in younger people; their curability is difficult and prognosis serious. Conclusion: Beside the well known correlation between developing of new head and neck cancer and bad habits (smoking, alcohol abuse, poor oral hygiene etc.) we should take into consideration the sexual promiscuity and alternative sexual practices. Vaccination against cervical cancer, recommended to young women, should be extended to their male partners to prevent the virus transmission and decrease the HNC incidence.

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.

Background: A cross-sectional study has been designed and the study observes the prevalence of polymorbidity in senior inpatients suffering from psychiatric morbidity hospitalized in gerontopsychiatric ward in one of the biggest psychiatric hospitals in the Czech Republic. The aim of the study is to prove that gerontopsychiatry is a comprehensive specialization for both doctors and nurses and should not be viewed as a low-status medical specialization. Methods and results: A cross-sectional study comprising of 304 patients was designed and a simple descriptive analysis of the patients' medical records was carried out. Polymorbidity and serious somatic conditions were present in senior patients hospitalized in gerontopsychiatric ward. Polypharmacy is a widespread phenomenon and has hazardous side effects for the treatment of patients. Last but not the least it also makes the treatment more expensive. Conclusion: Both doctors and nurses working in gerontopsychiatry should have a comprehensive interdisciplinary knowledge that would help in both early detection of many serious somatic conditions and in the improvement of the reputation of gerontopsychatry.

Backround. Ischemic mitral regurgitation (IMR) is a consequence of coronary artery disease and the main underlying mechanism is augmented leaflet tethering due to outward displacement of the papillary muscles. Although mitral annuloplasty combined with coronary revascularization is usually effective in the treatment of IMR, occasionally the regurgitation can persist or recur and this can affect patient prognosis. Methods: We searched Medline and Google scholar database for articles published since 1996 to June 2009. Search terms included ischemic mitral regurgitation, recurrent mitral regurgitation, persistent mitral regurgitation and annuloplasty failure. Conclusion: This article reviews current knowledge about IMR, the reasons and mechanisms of persistent and recurrent mitral regurgitation. We review clinic and echocardiographic predictive factors associated with persistence a recurrence of mitral regurgitation after annuloplasty.

Background: Insufficient venous vasculature disallows autologous arteriovenous fistula creation. In this case an arteriovenous conduit of expanded polytetrafluoroethylene (ePTFE) interponed between artery and vein is used for hemodialysis. Although arteriovenous graft infection is an infrequent complication, infected grafts cannot be used for hemodialysis and can cause infection, sepsis and bleeding. Treatment options remain limited but the general approach is to maintain functional angioaccess and to eradicate infection. Aim: to summarize current knowledge of the prevention and treatment of arteriovenous graft infection. Methods: literature review Conclusions. ePTFE graft present an unreplaceable material used for angioaccess in patients with an insufficient venous vasculature. A number of risk factors causing graft infection is known. Since hemodialysis patients are a highrisk group, an effective strategies for graft infection prevention and early diagnosis should be determined. Among the most important risk factors belong surgical procedure, recurrent venipuncture and other infection disease. The prostheses should be removed when infected, especially in the presence of sepsis. In case of "localized infection", the prostheses can be removed partially only under the condition of careful patient selection and subsequent follow-up.

Background: Increasing evidence from numerous research studies in internal medicine shows that adipocytes and adipokines are involved in primary inflammatory processes and disease. CORS-26 (collagenous repeat- containing sequence of 26 kDa protein) is a newly discovered adipokine of the C1q/TNF molecular superfamily C1q/TNF-related protein-3 (CTRP-3) secreted, inter alia in murine monocytes and adipocytes and in human adipocytes. Reported recently as a gene product of adipocyte differentiation, it shares structural similarity with the adipocyte, adiponectin. CORS-26 is much less known than other adipocytes such as leptin and resistin. Knowledge of its various functions has clinical and therapeutic implications especially in relation to obesity and the metabolic syndrome. Aims: This review aims to provide current knowledge of this adipokine. Methods: Review; sources were scientific biomedical databases Medline/PubMed, BioMedCentral, Google Scholar, Ovid, ProQuest from to 1998 to 2009. Conclusion: CORS-26 is an adipokine that regulates the secretion of other adipokines. Its effects on adipokine secretion are most probably independent of PPAR-γ. As CORS-26 up-regulates adiponectin secretion, it may be involved in metabolic and immunologic pathways. The effect of recombinant CORS-26 on insulin signaling in the presence of the metabolic syndrome needs to be investigated to further evaluate the physiological and pathophysiological role of this protein.

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.

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.

Aim: We present a case report of a female patient with metastasis of breast carcinoma to the medullary conus and cauda equina. Methods: A 48-year-old woman with a history of breast tumor, suddenly felt severe weakness and numbness of the lower extremities. MRI of the spine disclosed a mass lesion within the medullary conus, with leptomeningeal involvement of cauda equina at the spinal level L1. Laminectomy was performed and partial resection of the medullary conus tumor and especially release of nerve roots of cauda equina was achieved using microsurgical techniques. Results: Her clinical status, especially right leg weakness and sensory loss in the lower extremities have immediately improved but bladder dysfunction remained and she was unable to walk. The histological picture and immunophenotype indicates the presence of metastatic ductal adenocarcinoma of the mammary gland. Patient died 4 months after the spinal cord and cauda equina surgery. Conclusion: To our knowledge, this is the first report of successful surgical treatment of metastatic leptomeningeal infiltration of breast carcinoma.

Aims: The non-invasive ¹³C-methacetin (¹³C-MBT) breath test has been proposed as a measure of metabolic liver function that improves the diagnostic efficacy of serologic and biochemical tests in assessing hepatic functional capacity and liver disease severity, The goal of this study was to establish the clinical utility of this test in quantifying hepatic metabolic function in patients with liver cirrhosis of varying severity and to compare ¹³C-MBT measurements with the AST/ALT ratio, APRI score, and other routine liver tests. Methods: Routine liver function tests including serum bilirubin, aspartate aminotransferase activity (AST), alanine aminotransferase (ALT), AST/ALT ratio, the APRI score, the percentage of dose rate (PDR) and cumulative percentage of dose rate (CPDR) of the ¹³C-MBT were evaluated in 52 cirrhotic patients of alcohol etiology (Child-Pugh A/B/C 10/28/14) and 37 healthy controls. Results: The ¹³C-MBT differed significantly between healthy controls and cirrhotic patients at all time intervals measured. It also proved the ability to differentiate patients with liver cirrhosis based on severity of hepatic impairment corresponding to the Child-Pugh classification A vs. B vs. C. The ROC curve analysis suggested that the best prediction is provided by time intervals between the 10^th - 20^th or 10^th - 40^th minute of PDR. Conclusions: The ¹³C-MBT offers a reliable means for quantification of hepatic metabolic function over the complete range of functional liver impairment. It is non-invasive, easy to perform and completely safe.

Background: The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL_Smax) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q_REST), and to define the optimal cut-offs for SL_Smax to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). Methods and Results: In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL_Smax (r=-0.59, P<0.0001) and DE on ceCMR. The SL_Smax optimal cut-off -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL_Smax for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL_Smax resp. Q_REST, p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL_Smax than Q_REST in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SL_Smax resp. Q_REST, P=0.001). Conclusions: STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.

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.

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Aim: The aim of this study was to compare the quality of life after transcatheter aortic valve implantation (TAVI) and surgical replacement (SAVR) at one year. Methods: The study included 45 consecutive high-risk patients (average age 82.0 years; logistic Euroscore 22.3%) with symptomatic severe aortic stenosis allocated to TAVI transfemoral, TAVI transapical using the Edwards-Sapien valve or SAVR with the Edwards Perimount bioprosthesis (n=15 in each). The pre-operative characteristics were similar except for more myocardial infarctions in TAVI. The quality of life was assessed using the standardized EQ-5D questionnaire at baseline and on days 30, 90 and 360. The protocol was approved by the local ethics committee and an informed consent was signed. A total of 7 patients (15.5%) died during follow-up. Results: At baseline no significant differences in any of the quality-of-life parameters were found except for usual activities described as "best" (46.7% in SAVR vs. 10.0% in TAVI; P=0.002). At 30 and 90 days surviving patients were similar and at 360 days only the anxiety/depression score was "best" in 83.3% SAVR vs. 59.1% (P=0.046). Functional status improved in all patients (NYHA class I-II in 13.3% at baseline vs. 78.9% at 360-days) and the general health median significantly improved in TAVI patients (from 50 to 67; P=0.001) with a positive trend in SAVR patients (P=0.060). Conclusions: At one year, the general quality of life of high-risk patients had significantly improved after transcatheter aortic valve implantation with a positive trend in surgically treated patients.

Background: Patients with significant medical and social problems resulting from impaired perfusion of the upper limbs caused by micro- or macro-angiopathy are now frequent in clinical practice. Vasospastic disease of the upper limbs of combined origin is a difficult condition to treat by conservative methods and therapeutic strategies are usually multidisciplinary. In addition to standard pharmacotherapy, treatment may involve regional anaesthesia, thoracoscopic or radiofrequency sympathectomy and surgical treatment of defects, including plastic surgery. Methods: This paper describes our successful work in the treatment of upper limb critical ischemia using radiofrequency upper thoracic sympathectomy. Results: In three case reports we present the results of radiofrequency thermolysis applied to treat patients with chronic defects of the hand and fingers. These patients were diagnosed with upper limb critical ischemia of combined origin, standard conservative treatment methods failed and surgical intervention was originally not indicated, however, radiofrequency thermolysis proved to be beneficial. Conclusions: Radiofrequency thoracic sympathectomy could improve peripheral perfusion of the upper limbs and thereby contribute to healing of chronic defects, reduction of pain and improvement in the quality of life of the patients.

Aims: Restoration of renal function after kidney transplantation (KT) is expected to improve oxidative stress (OS). However, little is known about the influence of calcineurin inhibitors on oxidized low-density lipoproteins (ox-LDL) after KT. The aim of this study was to evaluate ox-LDLs and related markers of OS, advanced oxidation protein products (AOPP) and total antioxidant status (TAS) in patients after KT on either cyclosporin A (CyA) or tacrolimus (Tac) treatment. Methods: This was a prospective, randomized, single-center 12 month study evaluating time-dependent changes in biomarkers of OS before and after KT. Twenty nine patients (mean age 54.4 ± 11.1; 55% male and 45% female) were treated with CyA (Group A) and twenty four patients (mean age 52.9 ± 9.9; 75% male and 25% female) were treated with Tac (Group B). The ox-LDL, AOPP, TAS, lipid metabolism parameters, creatinine and glomerular filtration were assessed on day 1 before KT and on days 1 and 7, and in months 1, 3, 6 and 12 after KT. Results: Over the 12 months, the ox-LDL for group A changed from 69.2±32.9 to 65.1±17.1 U/L (P=0.665), while AOPP significantly decreased from 233.0±159.6 to 156.5±90.1 μmol/L (P=0.025) and TAS from 1.87±0.31 to 1.68±0.20 mmol/L (P=0.030). For group B the ox-LDL changed from 62.9±29.7 to ± 61.4±14.6 U/L (P=0.168) and TAS from 1.87±0.51 to 1.68±0.20 mmol/L (P=0.168), while AOPP significantly decreased from 180.5±90.0 to 123.9±37.7 μmol/L (P=0.019). Conclusion: AOPP is more sensitive than ox-LDL for assessing OS after KT. TAS values appear to be insufficiently sensitive for monitoring OS in patients after KT.

Aims: The aim of this study was to test the hypothesis that occult tumour cells in peritoneal lavage are a negative prognostic factor in pancreatic adenocarcinoma. Methods: Real-time RT-PCR analysis of CEA, EGFR and hTERT transcript levels was used to identify occult tumour cells in peritoneal lavage samples from 96 pancreatic cancer patients. Results: We found significant association between CEA expression levels in peritoneal lavage and clinical stage. We also found that EGFR transcript levels were higher in peritoneal lavage samples from patients with high grade tumours than in samples from patients with low grade tumours. Detection of CEA and/or EGFR occult tumour cell markers in the peritoneal lavage was associated with significantly shorter overall survival and increased hazard ratio for disease recurrence. Conclusions: The results show that the presence of occult tumour cells in peritoneal lavage is a negative prognostic factor for survival in pancreatic cancer patients, and that detection of occult tumour cells using PCR-based methods can identify patients with advanced disease for whom radical surgery is likely to have little benefit.