[Developmental impairment of children with very low and extremely low birth weight at 24 months corrected age, born in the Czech Republic in 2000-2009]. / Postizení vývoje detí s nízkou porodní hmotnostíve 24 mesících korigovaného veku, narozených v Ceské republice v letech 2000-2009.

OBJECTIVE: To evaluate the incidence of neonatal morbidity (NM), and developmental impairments (DIs) of very low (VLBW) and extremely low birth weight (ELBW) infants born in 2000-2009. DESIGN: Epidemiological study. SETTING: Outpatient clinics for children with perinatal risk at the regional neonatal centers. METHODS: Data on live born, specific neonatal mortality (SNM) and NM data were taken from the database the database of Institute of Health Information and Statistics of Czech Republic (IHIS CR). The incidence of DIs (cerebral palsy - CP, developmental delay - DD, growth retardation and sensory impairment) was evaluated at 24 months corrected age. Each cohort included newborn infants born always in the two-year periods.. Comparison of the incidence of DIs according to the birth-weight or to gestational age was performed in children born in 2009. RESULTS: 1. NM - in VLBW newborns, CNS morbidity and early indecisions decreased slightly (i.e. by 7 and 5%), other forms remained unchanged. In ELBW infants, CNS morbidity declined by 13.9% (p<0.05), early infections only by 5% (NS). - 2. DIs: - in VLBW infants, cerebral morbidity and early infections were reduced slightly (i.e. by 7 and 5% resp.). In ELBW category, CP decreased by 12%, and visual impairment by 9% (p<0.05). - 3. The occurrence of DIs by birth weight or gestational age did not differ, only in children <1000 g, in comparison with the group of <28 wks, was delayed growth increased by 6% (NS). - 4. In 2000-2007, SNM rate and also number of disabled children declined continuously. During period 2008-2009, in contrast to the previous 8 years, incidence of impaired children in both categories increased slightly (by 3%, and 1%, resp., NS). CONCLUSION: During the study period, SNM declined continuously, especially in the ELBW category. We managed to partially reduce NM (CNS and early infection), the problem remained late infection. In the period 2000-2007, incidence of DIs decreased, significantly in case of CP and visual impairment in ELBW children. Surprisingly in the last two years 2008-2009, there appeared in both categories an increase in the proportion of children with disabilities. It is a worrying finding, which should be re-evaluated.

[Changes in the developmental outcome of very low and extremely low birth weight infants at 24 months' corrected age born in 1997-2007]. / Zmeny incidence postizení vývoje u detí s velmi nízkou a extrémne nízkou porodní hmotností ve 24 mesících sicich korigovaného veku, narozených v letech 1997-2007.

OBJECTIVE: To describe the incidence of developmental impairments (DI) among very low birth weight (VLBW) infants at 24 months' corrected age, born in perinatal centers in 1997-2007, and evaluate their changing prognosis of intact development. DESIGN: Prospective epidemiological study. SETTING: Follow-up clinics of neonatal centers level III. METHODS: Live birth rate, in-hospital mortality, neonatal morbidity, DI and quality of survival were assessed. Neonatal morbidity was analyzed in periods 2000/2, 2003/5, and 2006/7 by the data of Institute of Health Informatics and Statistics. DI and quality of survival were evaluated in cohorts of VLBW infants born in 1997/9 (period I), 2000/2 (period II), 2003/5 (period III) and 2006/7 (period IV). RESULTS: Live birth rate of VLBW newborns in 1997-2007 increased in total of 39.5%, in-hospital mortality decreased, significantly in 1997-9 (fall of 10%). Neonatal morbidity, except infections, also declined. Significant decrease in DI-CP and visual impairment, was observed after period II, in category 1000-1499 g of 7/1.5%, in infants <1000 g of 8/7% resp. After period II, the prevalence of impaired children 1000-1499 g decreased of 5%, whereas in category < 1000 g only small decrease of 2% occurred in period III. Number of children without impairment increased gradually in both categories. CONCLUSIONS: The study showed significant increase in surviving VLBW infants, especially in category <1000 g. Increased survival rate at concurrent fall in severe neonatal morbidity (except infections) was not accompanied with worsened prognosis of an intact development.

Parameters describing the pulse wave.

Pulse wave analysis permits non-invasive assessment of arterial elasticity indices. The contour varies in different parts of the circulation. It depends on physiological or pathophysiological conditions of the organism. The pathological events like arteriosclerosis or diabetes have a primary effect to the artery elasticity. Hypertension or some heart diseases also influence the pulse wave velocity and resulted in earlier wave reflections. There are several methods of pulse wave measurements based on different principles and depending on the type of measured pulse wave. The evaluation parameters can be assessed from the time domain, derivations, velocity or frequency domain. The main aim of this review article is to offer a recent overview of pulse wave measurement parameters and main results obtained. The principles of pulse wave measurement and current experience in clinical practice are shortly discussed too.

In vitro study of reactive oxygen species production during photodynamic therapy in ultrasound-pretreated cancer cells.

Several recent studies bring evidence of cell death enhancement in photodynamic compound loaded cells by ultrasonic treatment. There are a number of hypotheses suggesting the mechanism of the harmful ultrasonic effect. One of them considers a process in the activation of photosensitizers by ultrasonic energy. Because the basis of the photodynamic damaging effect on cells consists in the production of reactive oxygen species (ROS), we focused our study on whether the ultrasound can increase ROS production within cancer cells. Particularly, we studied ROS formation in ultrasound pretreated breast adenocarcinoma cells during photodynamic therapy in the presence of chloroaluminum phthalocyanine disulfonate (ClAlPcS2). Production of ROS was investigated by the molecular probe CM-H2DCFDA. Our results show that ClAlPcS2 induces higher ROS production in the ultrasound pretreated cell lines at a concentration of 100 microM and light intensity of 2 mW/cm2. We also observed a dependence of ROS production on photosensitizer concentration and light dose. These results demonstrate that the photodynamic effect on breast cancer cells can be enhanced by ultrasound pretreatment.

Derivation of sonograph quality parameters by the use of point spread function analysis.

A measuring system evaluating a Point Spread Function generated in an ultrasonographic image by scanning a spherical target was developed. The target is moved in measuring bath filled by water over scanned volume via 3D computer controlled positioning system. A video signal obtained is converted to digital form and analyzed by original software to derive various objective parameters of the imager as follows: Focal areas in both the azimuth and the elevation directions, Ultrasound scanning lines visualisation, Manufacturer preloaded TGC, Width of the scanning plane, Side lobe levels and Amplification uniformity in the azimuth direction. The method was verified by testing 18 different equipments in 282 measurements. Samples of particular measurement results in form of graphical outputs are included. Medical and physiological impacts of this approach are discussed.

[Early maternal and neonatal morbidity after spontaneous and surgically-assisted vaginal delivery]. / Casná materská a neonatální morbidita po spontánním a operativním vaginálním porodu.

OBJECTIVE: To evaluate the differences in early maternal and neonatal morbidity after spontaneous delivery, forceps delivery and vacuum-extraction. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacký University, Olomouc. METHODS: The database of 8196 deliveries at our department in the time period from January 1995 till September 2000 revealed 183 of forceps deliveries and 217 of vacuum-extractions. The control group included 200 randomly selected parturients with spontaneous vaginal delivery. The early maternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd + IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence of episiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatal morbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia, duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age, birthweight and the presence of intracranial and retinal bleeding. The statistical significance of the differences in the frequency of the above parameters was evaluated. RESULTS: Spontaneous deliveries were associated with lower maternal morbidity according to the most of studied parameters. Vacuum-extraction had a lower frequency of maternal postpartum complications compared to forceps deliveries. Statistically valid differences were however found only at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics. The use of vacuum-extraction seems to be connected with a higher risk of cephalhematomas (p = 0.0051) and longer duration of hospitalization. CONCLUSIONS: From the point of view of early maternal morbidity the assisted vaginal delivery by vacuumextraction gives better results than by forceps. However vacuum-extraction increases the risk of cephalhematomas at newborn.

A method of local skin perfusion detection.

On the epidermal surface there are inhomogeneities which manifest as, among other things, lower local impedance. These regions include Head's zones, sweat glands, and also the so-called acupuncture points. The aim of this paper is to examine the effect of skin perfusion on epidermal impedance at the acupuncture points. When measuring epidermis impedance in the local (acupuncture) points the method of impedance plethysmography was applied. Both the method of four electrode measurement at the constant current and the method of two electrode measurement by means of the different and indifferent electrode as well were engaged. First, we had to uncover the size of the action skin points which was made by means of a different micro-electrode developed by us. The effect of some factors on the reproducibility and comparability of the values measured was evaluated. The attention was focused mainly on the questions of the pressure of the different electrode on the skin surface, magnitude and waveform of the exciting current, and so on. The authors demonstrate the impossibility to measure changes in skin impedance in the acupuncture points, in dependence on the blood perfusion--which was due to the high serial resistance between the point measured in the acupuncture place when the four-electrode measurement was applied, on the other side.

[Results of measurement of resolution capability of ultrasonographic equipment using our new method]. / Výsledky merení rozlisovací schopnosti sonografu získané nasí novou metodou.

The quality of sonographic instruments is vital for accurate medical diagnosis. To overcome one subjective problem associated with sonographic equipment, we have designed a system for objective instrument evaluation that is simple, accurate and valid. The system described fulfills the criteria for solving the outlined problem and enables us now to measure the parameters of both the axial and transversal resolutions. Additionally we can appreciate dynamic range of signal, gray scale parameters, the amplitude of video-signal and level of side lobes. To evaluate our method we examined two sonographies with different transducers working on the frequencies of 3 and/or 5 MHz. The method gives reliable results for sonographies quality assessment.

[The concept of practical teaching of medical informatics at the Medical School of Palacký University in Olomouc]. / Koncepce praktické výuky lékarské informatiky na Lékarské fakulte Univerzity Palackého v Olomouci.

The method and conditions of medical information technology teaching represent a direct reflection of both significant progress of information technology and change in public approach to computer techniques. Over the years, the content of the course has been changed to a large extent. It is a result of the existing wide scale of available program products, modernization of local computer network and information technology classrooms and especially common attempt to availability of Internet. The computer-literacy of students is increasing as well as the number and quality of specialized teaching programs and demands of theoretical subjects of study. However the level of computer-literacy of individual students is getting to be widely different. In answer to this situation our institute reacts by some measures, described here. The aim of this paper is to raise a discussion about them and about this issue and to learn more about the approaches and practise in other institutes. In our opinion, a general integration of the main features of the medical information technology teaching courses at Medical Faculties would be the most effective result.

[Financing of education and research in universities]. / Jak dále s financováním výuky a vedy na vysokých skolách.

Universities in the Czech Republic undergo a process of deep changes. There are different perspectives concerning the correctness of the way started with this process. This contribution shows the possibilities which the ministry of Education, Youth and Sports can use to support the quality of teaching as well as the quality of science and research at our universities. The possibilities of evaluation of schools are rather problematic but to find a way of evaluation of the schools is absolutely necessary. There are certain parameters devised in this contribution which will be later elaborated into formulas, then modified in the way which enables that they can be used in the higher education budget allocation in the following year. In the area of research and development there is an evident pressure from the Ministry on the Government to increase the institutional funding of research and development. This funds will be distributed according to the "Rules for the evaluation of research intentions and results of organizations from the view point of the institutional funding provisions for research and development".

[Laparoscopic cholecystectomy]. / Laparoskopická cholecystektomie.

The authors present an account of their experience assembled during one year with laparoscopic operations of the gallbladder. They indicated 248 patients for CHE incl. 237, i.e. 95.6%, for laparoscopic CHE. No deaths, no major complications, 6.5% conversions in elective indications, 23% in acute indications. Six patients with residual choledocholithiasis are in the authors' opinion a signal calling for more accurate detection of CHLDL before and during LCHE.