Quality of preimplantation embryos recovered in vivo from dairy cows in relation to their body condition.

This study examined the impact of cow body condition on the quality of bovine preimplantation embryos. The embryos (n = 107) were flushed from dairy cows and classified according to a five-point scale body condition score (BCS2 n = 17; BCS3 n = 31; BCS4 n = 11) on the 7th day after insemination and then analyzed for development, dead cell index (DCI), cell number and actin cytoskeleton quality. The highest embryo recovery rate (P < 0.05) was recorded in the BCS3 group and the lowest in the BCS4 group. More transferable (morula, blastocyst) embryos were obtained from the BCS4 cows (79%), compared with the BCS2 (64%) or BCS3 (63%) animals. However, cell numbers were higher in the BCS2 and BCS3 groups (P < 0.05) compared with the BCS4 embryos. Conversely, the DCI was lowest in the BCS2 (3.88%; P < 0.05) and highest in the BCS4 (6.56%) embryos. The proportion of embryos with the best actin quality (grade I) was higher in the BCS2 and BCS3 cows compared with the BCS4 group. Almost 25% of all embryos showed fragmented morphology and a higher DCI (5.65%) than normal morulas (1.76%). More fragmented embryos were revealed in the BCS2 (28.6%) and BCS4 (31.25%) groups, and less (19.15%) in the BCS3 group. The cell numbers in such embryos were lower in the BCS4 (22.57) than in the BCS2 (46.25) or BCS3 (42.4) groups. In conclusion, the body condition of dairy cows affects the quality of preimplantation embryos. A BCS over 3.0 resulted in a higher incidence of poor (fragmented) embryos.

Relationships between milk fatty acids composition in early lactation and subsequent reproductive performance in Czech Fleckvieh cows.

Increase of milk yield after calving causes changes in milk fatty acids (FA) composition and simultaneously corresponds with reproduction performance decrease. The objective of this study was to evaluate the relationships between milk FA group composition (SFA, saturated fatty acids; MUFA, monounsaturated fatty acids; and PUFA, polyunsaturated fatty acids) during the first 5 lactation weeks and subsequent reproductive results (INT, calving to first service interval; NUM, number of services per conception, and DO, days open) in Czech Fleckvieh cows. A total of 1231 individual milk samples from 382 cows were collected and subsequently analyzed. Simultaneously, body condition score (BCS) was weekly evaluated as well. Software SAS 9.1 was used for statistical analysis. Daily milk yields increased whereas BCS, milk fat and protein contents decreased during period observed. The reduction of basic milk components (% of fat, % of protein) was associated with increased SFA and decreased MUFA, respectively PUFA contents. Significant (P<0.01-0.05 days) increase in NUM (+0.15 to +0.29 AI dose) and DO (+8.16 to 15.44 days) were detected in cows with the lowest SFA content. On the contrary, cows with the highest content of MUFA presented significantly (P<0.01-0.05) higher values of NUM (+0.13 to +0.30) and DO (+7.26 to +15.35 days). Milk FA groups composition in early lactation potentially used as NEB indicators, especially SFA and MUFA proportion, affected subsequent reproductive results of Czech Fleckvieh cows. Therefore, its post-partum values could serve as predictors of potential fertility of dairy cows.

Relationships among the cervical mucus urea and acetone, accuracy of insemination timing, and sperm survival in Holstein cows.

The objectives of this study were to evaluate the relationships among urea and acetone content in cows' cervical mucus (CM), its crystallization type (CT) and sperm survival (SS) after timed AI. Samples of CM were collected from 192 Holstein cows treated by Ovsynch(®) protocol. Analysis of the urea and acetone content for identification of the metabolic status, the arborization test for evaluation of insemination timing and the short-term heat test of SS for assessment of its suitability as a biological matrix were performed. The data set was analyzed by the GLM procedure using SAS(®). The results documented the existence of substantial differences in individual response to the Ovsynch(®) protocol causing insemination of 55.2% cows at an inappropriate time. The urea content was found as a possible indicator of a cow's metabolism and/or of insemination timing, concentrations of less than 500 mg/L corresponded (P<0.05-0.01) to the cows' expected response to timed AI. The greater the urea content, the greater the proportion of cows inseminated at an inappropriate time. Effects (P<0.05-0.01) of CT, urea and acetone content on SS were determined. The greatest values of SS were detected in cows with an expected response to precisely timed oestrus documented by the corresponding CT. Greater values of urea (>260 mg/L) and acetone (>5mg/L) negatively affected SS as well (P<0.05-0.01). The results confirmed that the accuracy of insemination timing can be affected by the metabolism intensity, just as CM quality directly influences sperm survival.

[Psychosocial interventions by stillbirth in history and today]. / Psychosociálná intervence pri porodu mrtvého plodu v historii a dnes.

OBJECTIVE: A goal of this article is to give a review about psychosocial interventions, which health professionals use to support parents with stillbirth, about their historical development and their usage in perinatology centres in the Czech republic now. DESIGN: A review article. SETTING: Faculty of Health Care Studies, University of West Bohemia; Department of Psychiatry, University Hospital in Pilsen. SUBJECT AND METHOD: A review of literature and research in perinatology centres in the Czech republic. CONCLUSION: Researches recent demonstrate a sense of critical usage of rituals at stillbirth, which give support to creating realistic attitudes to loss and initiation of the mourning process by parents, parallel with the minimisation of subsequent psychical complications by parents in long-term outcomes. In perinatological centres in the Czech republic parents can see or hold their death baby. Momentoes of the child, recommended by professional researches, are rarely collected and used there.

Lower serum levels of interleukin-6 in a population sample with symptoms of depression than in a population sample without symptoms of depression.

In this study we compared the levels of interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor-alpha (TNF-alpha) in population samples characterized by a high or low level of self-reported depression. We measured serum IL-6, IL-8, IL-10 and TNF-alpha in two cohorts which differed in scoring on the Zung Self-Rating Depression Scale (ZSDS). The group with a high score in ZSDS (average SDS index = 62.9) was called DEP (n=27), the group with a low score in ZSDS (average SDS index = 29.9) was called NDEP (n=16). The groups did not significantly differ in age, waist circumference and body mass index. For the assessment of serum cytokine levels multiplex immunoanalytic xMAP(LUMINEX) technology was used. We found lower IL-6 in the DEP group (medians; DEP 4.08 pg/ml vs. NDEP 6.11 pg/ml) on the border of statistical significance in multiple regression analysis (p=0.049). Serum levels of all other studied cytokines were not significantly different (medians; IL-8: DEP 2.18 pg/ml vs. NDEP 2.61 pg/ml; IL-10: DEP 2.85 pg/ml vs. NDEP 2.94 pg/ml; TNF-alpha: DEP 2.32 pg/ml vs. NDEP 2.30 pg/ml). These results are in contradiction to the prevailing opinion that pro-inflammatory cytokine levels are elevated in people with symptoms of depression.

The law(s) of the rings: boxing and the law.

To threaten harm is to assault and to realise that threat is to batter. To do so intentionally for the purpose of producing injury amounts to causing harm with intent and one cannot consent to be the victim of such violence. Despite these clearly enunciated legal principles, such conduct is routinely practised in the name of sport. Boxing is widely accepted as a highly paid professional sporting activity in which the ultimate goal is to inflict a concussive head injury upon an opponent or at least cause sufficient damage to render an opponent incapable of further self-defence. Spectators pay to watch the anticipated systematic abuse of one human being by another in much the same way they delighted in gladiators who were forced to fight for the pleasure of others. This article reviews these concepts and challenges the legal ethics of authorised violence associated with these activities undertaken in the name of sport.

A new adjuvant improves the immune response to hepatitis B vaccine in hemodialysis patients.

Prehemodialysis and hemodialysis patients are at an increased risk of hepatitis B infection and have an impaired immune response to hepatitis B vaccines. We evaluated the immune response to the new adjuvant of hepatitis B vaccine AS04 (HBV-AS04) in this population. We measured antibody persistence for up to 42 months, and the anamnestic response and safety of booster doses in patients who were no longer seroprotected. The primary vaccination study showed that HBV-AS04 elicited an earlier antibody response and higher antibody titers than four double doses of standard hepatitis B vaccine. Seroprotection rates were significantly higher in HBV-AS04 recipients throughout the study. The decline in seroprotection over time was significantly less in the HBV-AS04 group with significantly fewer primed patients requiring a booster dose over the follow-up period. Solicited/unsolicited adverse events were rare following booster administration. Fifty-seven patients experienced a serious adverse event during the follow-up; none of which was vaccine related. When HBV-AS04 was used as the priming immunogen, the need for a booster dose occurred at a longer time compared to double doses of standard hepatitis B vaccine. Hence, in this population, the HBV-AS04 was immunogenic, safe, and well-tolerated both as a booster dose after HBV-AS04 or standard hepatitis B vaccine priming.

Tick-borne encephalitis (TBE) vaccination: applying the most suitable vaccination schedule.

Tick-borne encephalitis (TBE) is caused by an arthropod-borne virus, belonging to the family of Flaviviridae. In case of disease, which can lead to neurological sequelae or even fatal outcomes, only symptomatic treatment is available. TBE can be prevented by vaccination. Various primary immunization schedules have been developed. To identify the most suitable schedule, the present randomised, controlled study was designed to provide data on the immune response elicited by four different immunization schedules obtained by ELISA and by neutralization test (NT). A total of 398 healthy subjects aged > or =12 years were randomised to vaccination according to either the rapid schedule (Group R, vaccination on days 0, 7 and 21), the conventional schedule (Group C, vaccination on days 0, 28 and 300), the modified conventional schedule (Group M, vaccination on days 0, 21 and 300) or the accelerated conventional schedule (Group A, vaccination on days 0, 14 and 300). Within 3 weeks (i.e. by day 21) antibody levels were higher in Group R and Group A than in Group M and Group C. Group R and Group C both had higher titres on days 42, 180 and 300, than Group A and Group M. The rapid schedule thus combines the advantages of fast protection and of high titres over the observation period of 300 days.

[Diabetes mellitus and immunization]. / Diabetes mellitus a imunizace.

Principles of prevention of infectious diseases have been known for several thousands of years. One of the most significant tools of infection prophylaxis is immunization. Vaccines containing thymus-dependent antigens produce massive and complex immune response and feature immunologic memory. That is why they can successfully protect patients with diabetes. Lately, it has been thought by general public and even experts that application of vaccines within national immunization programmes is one of the etiopathogenetic factors in the development of type 1 diabetes mellitus (DM). However, analysis of extensive studies performed by the experts of the Institute for Vaccine Safety proved that there is no positive or negative impact of immunization on the development of type 1 diabetes mellitus. The basic vaccinations recommended for diabetics include immunizations against influenza, pneumococcal infections, tetanus and viral hepatitis B. Other vaccines are administered only after individual assessment of benefits and risks for the diabetic patient. Most often, these are vaccinations against viral hepatitis A, tick-borne encephalitis, meningococcal infections and other infections that put in risk diabetic patients travelling abroad.

Safety and immunogenicity of a combined vaccine against hepatitis A and B in patients with autoimmune hepatitis.

Patients with autoimmune hepatitis (AIH) are a group at risk of disease exacerbation or relapse of the underlying disease should they fall ill with infectious hepatitis A (HAV) or B (HBV). Therefore, it seems appropriate to protect this group of persons against HAV and HBV disease by vaccination. An open study evaluated the safety, reactogenicity and immunogenicity of a combined HAV and HBV vaccine in 10 patients with AIH (6 patients aged 1-15 years and four patients aged 16+ years). The vaccine was administered using a three-dose vaccination schedule (0, 1 and 6 months). The vaccine course was well tolerated, safe and did not aggravate the clinical course of the underlying disease. Patients responded with 100% seroconversion for antibody to the HAV vaccine component and geometric mean antibody concentration (GIVIC) comparable to healthy cohorts. Response to the HBV component antigen was comparable to previous reports of HBV vaccination in immune compromised individuals with lower GMC than observed in healthy populations. One month after the third vaccine dose (month 7), all six vaccinees in the 1-15 years age group developed protective levels of anti-HBs as compared to two of the four vaccinees in the 16+ years age group.

Safety and immunogenicity profile of an experimental hepatitis B vaccine adjuvanted with AS04.

The reactogenicity and safety of an experimental hepatitis B (HB) vaccine containing adjuvant system (AS04) was compared with a licensed vaccine in a phase III, single-blind, randomised study in healthy volunteers >or=15 years of age. A total of 1303 subjects were enrolled to receive either two doses of HB-AS04 (0, 6 months) or three doses of the comparator vaccine (0, 1, 6 months). Two doses of HB-AS04 elicited seroprotection rates close to 100% and two-fold higher GMTs than the comparator vaccine. Results showed that both vaccines were well tolerated and the general safety profile of HB-AS04 was similar to that of the comparator vaccine.

Long term and repeated electron microscopy and PCR detection of Borrelia burgdorferi sensu lato after an antibiotic treatment.

The diagnosis of Lyme disease in 18 patients has been proved by detection of Borrelia burgdorferi sensu lato when using immunoelectron microscopy or detecting its nucleic acid by PCR in the plasma or the cerebrospinal fluid. The positive results occurred in the plasma or in the cerebrospinal fluid in the period of 4-68 months after an antibiotic treatment. The typical clinical manifestations of Lyme disease were observed in 9 patients and non-specific symptoms in another 9 patients. According to presented results we can recommend repeated examination using PCR of the plasma and other biological specimens in the individuals with persistent or recurring complaints after an acute form of Lyme disease and its antibiotic treatment. Also examination of the cerebrospinal fluid with non-specific symptoms and simultaneously displayed pathology electroencephalogram and/or magnetic resonance imaging findings can be advantageous.

Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop.

BACKGROUND: Plasmodium vivax is the second most common species among malaria patients diagnosed in Europe, but epidemiological and clinical data on imported P. vivax malaria are limited. The TropNetEurop surveillance network has monitored the importation of vivax malaria into Europe since 1999. OBJECTIVES: To present epidemiological and clinical data on imported P. vivax malaria collected at European level. MATERIAL AND METHODS: Data of primary cases of P. vivax malaria reported between January 1999 and September 2003 were analysed, focusing on disease frequency, patient characteristics, place of infection, course of disease, treatment and differences between network-member countries. RESULTS: Within the surveillance period 4,801 cases of imported malaria were reported. 618 (12.9%) were attributed to P. vivax. European travellers and immigrants were the largest patient groups, but their proportion varied among the reporting countries. The main regions of infection in descending order were the Indian subcontinent, Indonesia, South America and Western and Eastern Africa, as a group accounting for more than 60% of the cases. Regular use of malaria chemoprophylaxis was reported by 118 patients. With 86 (inter-quartile range 41-158) versus 31 days (inter-quartile range 4-133) the median symptom onset was significantly delayed in patients with chemoprophylaxis (p < 0.0001). Common complaints were fever, headache, fatigue, and musculo-skeletal symptoms. All patients survived and severe clinical complications were rare. Hospitalization was provided for 60% and primaquine treatment administered to 83.8% of the patients, but frequencies varied strongly among reporting countries. CONCLUSIONS: TropNetEurop data can contribute to the harmonization of European treatment policies.

[100 CT-guided pelvic operations]. / 100 CT navigovaných operací pánve.

PURPOSE OF THE STUDY: The authors present their 10-year experience with the computed tomography (CT) assisted insertion of implants in the sacroiliac (SI) region and acetabular region. Indications for these interventions and their detailed descriptions are reported. MATERIAL: A total of 98 patients, with the average age of 40.7 years and prevalence of men (70%), were treated. The most frequent cause of injury was a car accident, second in rank was fall from a height. Of these patients, 86 were followed up from 2 months to 3 years. METHODS: The surgical procedure was carried out in the CT department, in which conditions were provided to meet the criteria of an operating theatre. Computed tomography was used to plan the exact position of the implant and, during the procedure, to guide its precise insertion. These procedures required close cooperation of the surgeon and radiologist. A total of 73 CT-guided operations were performed on the SI region, using iliosacral screws or sacral rods. The operation was always preceded by surgery on the anterior pelvic segment. Iliosacral screws were also used in six patients operated on for pseudoarthrosis of the sacrum or chronic instability of the SI joint. The screws were also used in 19 patients who underwent surgical intervention in the acetabular region; in 14 cases it was for a fracture of the acetabular rim. All procedures were carried out by this minimal invasive technique. RESULTS: In all cases, correct insertion of the implant was achieved. There was only one serious preoperative complication due to the fact that the guidewire deviated from its planned direction without this being shown by CT scan. A late infectious complication following iliosacral screw application was recorded in one patient and, in another patient, a nut loosened on one side of the sacral rod. These implants, temporally immobilizing the SI joint, were removed at periods of 6 to 9 months after the operation. There was no case of secondary dislocation of the SI joint after the implant was removed. Complete bony healing of the fractures treated, including pseudoarthrosis, was achieved in all our patients. A comprehensive evaluation of the clinical results of CT-guided operations was difficult because of large inter-individual differences in the extent of pelvic injuries. DISCUSSION: CT-guided interventions are currently indicated predominantly for fractures of the sacrum or displacement of the SI joint up to a 15 mm distance. It is necessary to re-evaluate the extent of displacement after an exact reconstruction of the anterior pelvic segment and restoration of the anatomical conditions. The displacement in the posterior segment usually becomes markedly reduced. The simultaneous surgical treatment of both the anterior and posterior pelvic segments results in restoration of pelvic girdle continuity and maintenance of good stability of the pelvis. This permits early rehabilitation and mobilization of the patient. Other conditions indicated for CT-guided surgery include simple fractures of the acetabular rim with a distance between the fracture lines up to 7 to 10 mm, usually following hip dislocation, and simple oblique fractures of the acetabular columns. CONCLUSIONS: The CT-guided surgical procedure allows us to assess both the shape and course of fracture lines or distance between the injured structures. It also enables us to choose the optimal direction, in relation to these structures, for an implant to be inserted and to respect important anatomical structures in the surroundings. It helps us to determine the exact length of implants to be used. During the procedure, repeated CT scans facilitate checking the direction and position of both instruments and implants. In the closing phase of the operation, it is possible to assess closeness of the bones screwed together, the definitive placement of the implants and their reliable fixation. This method also permits to check whether a screw did not penetrate through the opposite cortical bone.

[Problem situations between health personnel and patients. Qualitative analysis of medical and psychological aspects of the complaints]. / Problémové situace mezi zdravotníky a pacienty. Kvalitativní analýza stízností z medicínsko-psychologického hlediska.

Paper deals with problems of patient's complaint about the activity of health care workers. Author submits his findings resulting from the qualitative analysis of individual cases, which are aimed at cases with medical and psychological aspects (namely in the communication). Exchange of information between the health care workers and patients belongs to the most risky situations from the point of complaint. As a conclusion, some preventive measures are recommended.

Imported schistosomiasis in Europe: sentinel surveillance data from TropNetEurop.

BACKGROUND: Schistosomiasis is a major parasitic disease, increasingly imported into temperate climates by immigrants from and travelers to endemic areas. METHOD: To generate valid data on imported infectious diseases to Europe and to recognize trends over time, the European Network on Imported Infectious Diseases Surveillance (TropNetEurop) was founded in 1999. Three hundred and thirty-three reports of schistosomiasis were analyzed for epidemiologic and clinical features. RESULTS: Male patients accounted for 64% of all cases. The average age of all patients was 29.5 years. The majority of patients were of European origin (53%). Europeans traveled predominantly for tourism (52%). Main reasons for travel for people from endemic areas were immigration and refuge (51%) and visits to relatives and friends (28%). The majority of infections were acquired in Africa; 92 infections were clearly attributable to Schistosoma haematobium, 130 to Schistosoma mansoni, and 4 to Schistosoma intercalatum. Praziquantel was the only treatment used. No deaths were recorded. CONCLUSION: TropNetEurop sentinel provides valuable epidemiologic and clinical data on imported schistosomiasis to Europe.

Age as a risk factor for severe manifestations and fatal outcome of falciparum malaria in European patients: observations from TropNetEurop and SIMPID Surveillance Data.

Previous studies have indicated that age is a risk factor for severe falciparum malaria in nonimmune patients. The objectives of this study were to reevaluate previous findings with a larger sample and to find out how strongly clinical outcomes for elderly patients differ from those for younger patients. Results of adjusted analyses indicated that the risks of death due to falciparum malaria, of experiencing cerebral or severe disease in general, and of hospitalization increased significantly with each decade of life. The case-fatality rate was almost 6 times greater among elderly patients than among younger patients, and cerebral complications occurred 3 times more often among elderly patients. Antimalarial chemoprophylaxis was significantly associated with a lower case-fatality rate and a lower frequency of cerebral complications. Women were more susceptible to cerebral complications than were men. Our study provides evidence that falciparum malaria is more serious in older patients and demonstrates that clinical surveillance networks are capable of providing quality data for investigation of rare events or diseases.

Effectiveness of vaccination against influenza in SkodaAuto Company employees during the influenza season 2000-2001.

The SkodaAuto management evaluated the effectiveness of vaccination within the course of the influenza season, 2000 - 2001. All 23,782 company employees working in the plants at Mladá Boleslav, Vrchlabí, and Kvasiny were enrolled into the study, of which 5,079 (21.3%) agreed to be vaccinated against influenza in the autumn, 2000. In comparison with the preceding years, two- to three-fold more employees were vaccinated. During the study period (i.e. between the 4th and 13h week of 2001), 67 (1.3%) individuals from the vaccinated group and 1,297 (6.9%) from the non-vaccinated group fell ill due to influenza or an influenza-like disease (i.e. a five-fold difference). The morbidity peak appeared in the 5th and 6th calendar week with the number of sick reaching nearly 300 during the latter. The morbidity from acute respiratory disease (ARD) in the district of Mladá Boleslav in calendar week 6 was 484 per 10,000 inhabitants which was nearly twice that of the national average. Overall, influenza-related morbidity in the SkodaAuto Company was 4 to 7 times lower than ARD in the Mladá Boleslav district; whereas the respective values in the vaccinated group were up to 10-fold lower. The vaccination effectiveness reached 81.2%.